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Traumatic optic neuropathy in children: a prospective study
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi.
Insights
Pediatric optic nerve injury, often from falls or accidents, can cause visual impairment. Conservative treatment with corticosteroids is common, with surgery benefiting some children with static vision post-injury.
Area of Science:
- Ophthalmology
- Pediatric Traumatology
- Neurology
Background:
- Indirect optic nerve injury is a significant cause of visual impairment in children.
- This study focuses on a specific cohort of 50 children managed over an 8-year period.
Purpose of the Study:
- To delineate the clinical profile of pediatric indirect optic nerve injuries.
- To evaluate the effectiveness of conservative management and surgical interventions.
- To identify indications for optic nerve decompression in pediatric cases.
Main Methods:
- Prospective study of 50 children with indirect optic nerve injury.
- Analysis of injury mechanisms, visual impairment, skull fractures, and neurophysiological tests (Visual Evoked Potentials).
- Evaluation of outcomes following conservative treatment (corticosteroids) and surgical optic nerve decompression.
Main Results:
- Falls and road traffic accidents were primary causes of injury.
- 43 children had unilateral and 7 had bilateral visual impairment; 5 experienced delayed onset.
- 40% of children showed spontaneous visual improvement within 3 weeks; surgery benefited 4 of 7 children with static vision, but not those with no light perception.
Conclusions:
- Indirect optic nerve injury in children presents with diverse clinical features and varying visual outcomes.
- Conservative management with corticosteroids is the initial approach.
- Optic nerve decompression may improve vision in select cases with static vision, but is unlikely to benefit those with pre-operative no light perception.
Abstract:
Fifty children with indirect optic nerve injury were prospectively studied over an 8-year period. They constituted 20% of all patients with optic nerve injury managed on a slightly different protocol. Half of these children were injured due to fall from a height, followed by road traffic accidents in 40% of the cases. Forty-three children had unilateral and 7 children had bilateral visual impairment. Five children had definite history of delayed-onset visual involvement, which ranged from 12 to 72 h following injury. Fifty percent of these children had fractured skulls and 14% had optic canal fracture. Visual evoked potentials were performed in 43 patients of which wave formation was normal in 7 and abnormal in 14 patients. The remaining 22 patients had no wave formation. All the patients were managed conservatively and received corticosteroids for a period of 3 weeks. In 7 children an optic nerve decompression was performed between 4 and 6 weeks following injury. Spontaneous visual improvement was observed in 20 (40%) children. In all the patients onset of visual recovery was noticed within 3 weeks. Of the 7 children who had optic nerve decompression, 4 had minimal spontaneous recovery and their vision remained static. All these 4 children benefited by surgery and the vision improved further following the decompression. Three children had no perception of light prior to surgery and none of these patients showed visual improvement following surgery. The present study brings out the clinical profile of children with optic nerve injury and the indications of surgery in these patients.