Intravenous methylprednisolone in treatment of traumatic optic neuropathy

Traumatic optic neuropathy is one of true ophthalmic emergencies and there is no proven form of treatment for traumatic optic neuropathy. Here we were presented with 30 cases of sudden visual loss following blunt eye trauma seen in Kaohsiung Medical College Hospital, Taiwan from April 1994 to March 1997. We analyze the treatment style, visual acuity, elapsed time since injury and orbit computed tomography retrospectively. Among them, 21 cases received intravenous methylprednisolone treatment, 2 cases received oral prednisolone, 2 cases underwent optic canal decompression in addition to intravenous methylprednisolone and 5 cases were carefully monitored without any kind of treatment. Thirteen of the 21 cases (62%) in intravenous methylprednisolone group got visual improvement. Patients with initial vision better than light perception benefitted more from treatment than did the patients who with no light perception in medical treatment group (85% VS 20%) (p < 0.05). Thirteen of the 30 cases (53.3%) had orbit fracture and 2 of the 30 cases (6.7%) had a fracture of the optic canal. These two cases also received optic canal decompression surgery in addition to intravenous steroid treatment but the prognosis was poor. In conclusion, intravenous methylprednisolone does offer help in traumatic optic neuropathy. Whether or not initial visual acuity was better than light perception was a key risk factor in the outcome. In this article, we also compare our results with other series in the literature and found that the value of different treatment in traumatic optic neuropathy still needs to be prospectively judged in the future.