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Post-traumatic optic neuropathy: our surgical and medical protocol
E Emanuelli1, M Bignami2, E Digilio2
1Department of Otorhinolaryngology and Otology Surgery of the University of Padova, via Giustiniani 2, Padua, Italy. enzoemanuelli@libero.it.
Summary
Post-traumatic optic neuropathy (TON) treatment remains unclear. A combined approach of early steroid therapy followed by endoscopic optic nerve decompression improved visual acuity in 65% of patients with minimal complications.
Area of Science:
- Ophthalmology
- Neurosurgery
- Trauma Care
Background:
- Post-traumatic optic neuropathy (TON) is a severe injury causing vision loss.
- No definitive treatment strategy currently exists for TON.
- Road traffic accidents are the most common cause of TON.
Purpose of the Study:
- To evaluate the efficacy and safety of a combined medical and surgical treatment protocol for TON.
- To determine the optimal timing for intervention in TON management.
Main Methods:
- Retrospective review of 26 patients treated between 2002 and 2013.
- All patients received initial systemic corticosteroid therapy.
- Surgical treatment involved endonasal endoscopic decompression of the optic nerve.
Main Results:
- Visual acuity improved in 65% of patients.
- Surgery performed closer to the injury time yielded better results.
- No intra- or post-operative complications were reported.
Conclusions:
- A protocol of early intravenous steroid treatment followed by endoscopic optic nerve decompression offers a favorable risk-benefit ratio.
- Prompt surgical intervention, ideally within 12-24 hours of medical therapy initiation, is crucial for visual recovery.
- Further evidence-based research is needed to establish a gold standard for TON treatment.
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