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traumatic optic neuropathy, steroid, no light perception

I-Li Lai, Han-Tsung Liao, Chien-Tzung Chen
BACKGROUND: Although recent evidence suggests a controversy effect of steroids in the management of indirect traumatic optic neuropathy (TON), steroid pulse therapy remains one of the reasonable treatments for patients with indirect TON. It is thought that microcirculatory spasms, edema, and nerve cell necrosis can be prevented or reduced by large doses of steroids. The aim of this study is to analyze the predisposing factors for the recovery of patients with indirect TON who were treated with steroid pulse therapy...
March 2016: Annals of Plastic Surgery
Rupesh Agrawal, Mehul Shah, Kamiar Mireskandari, Goh Kong Yong
Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide...
August 2013: International Ophthalmology
Rebecca L Ford, Vickie Lee, Wen Xing, Catey Bunce
BACKGROUND: To report epidemiologic data on traumatic optic neuropathy (TON) in patients less than 18 years of age in the United Kingdom acquired by prospective population-based active surveillance through the British Ophthalmic Surveillance Unit. METHODS: Data were obtained from incident and 6-month follow-up questionnaires sent to reporting ophthalmologists over a period of 2 years. Main outcome measures were demographic data, clinical and visual function at presentation and follow-up, investigations, and treatments used...
October 2012: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Qin-Tai Yang, Ge-Hua Zhang, Xian Liu, Jin Ye, Yuan Li
BACKGROUND: Traumatic optic neuropathy (TON) is an important cause of severe loss of vision due to blunt or penetrating head trauma. The pathogenesis of TON remains unclear, and there are several potential causes for the observed loss in vision. Endoscopic optic nerve decompression (EOND) has been reported to improve the visual prognosis in TON cases, but its efficacy remains controversial. It is important to investigate the therapeutic efficacy of EOND in the treatment of TON and to evaluate the relevant prognostic factors...
May 2012: Journal of Trauma and Acute Care Surgery
Wencan Wu, David I T Sia, Paul S Cannon, Dinesh Selva, Yunhai Tu, Jia Qu
A 59-year-old Chinese man presented with no light perception in the left eye 1 day following functional endoscopic sinus surgery. The patient underwent endoscopic optic nerve decompression with topical and systemic application of nerve growth factor and steroids after a failed trial of high-dose intravenous corticosteroids. Visual acuity improved to 20/25 at 3 weeks and remained stable at 9 months. Reports of full visual recovery are exceedingly rare following this functional endoscopic sinus surgery complication...
January 2011: Ophthalmic Plastic and Reconstructive Surgery
Ke-Jun Zuo, Jian-Bo Shi, Wei-Ping Wen, He-Xin Chen, Xiang-Min Zhang, Geng Xu
OBJECTIVE: To explore the outcome of transnasal endoscopic optic nerve decompression (TEOND) for traumatic optic neuropathy (TON). METHODS: The clinical data of 155 consecutive patients with TON treated with TEOND after failure of mega-dose steroid therapy were retrospectively analyzed, their outcomes were summarized after follow-up, and then Logistic regression was used to analyze the prognosis-related information to explore the factors influencing prognosis. RESULTS: Patients were followed up for 3 - 60 months...
February 17, 2009: Zhonghua Yi Xue za Zhi [Chinese medical journal]
V Lee, R L Ford, W Xing, C Bunce, B Foot
AIMS: The aim of this study is to provide epidemiological data on the incidence, aetiology, management, and visual outcome in traumatic optic neuropathy (TON) in the UK. METHODS: Patients with TON were identified prospectively by population-based active surveillance through the British Ophthalmic Surveillance Unit over a 2-year period with data obtained from an incident questionnaire and follow-up questionnaire sent to positive reporters. RESULTS: Incident and follow-up data were available on 121 and 97 (80%) patients, respectively...
February 2010: Eye
H Das, B P Badhu, M A Gautam
To report the demography, nature of insult and ocular characteristics in patients presenting with indirect traumatic optic neuropathy and to evaluate the visual outcome with mega dose methylprednisolone therapy. Retrospective hospital data analysis of all patients admitted with indirect traumatic optic neuropathy and treated with mega dose methylprednisolone therapy in the last three years was conducted. Nine patients (M:F= 8:1) were identified with unilateral optic nerve injury. Road traffic injury was the most common cause of injury...
April 2007: JNMA; Journal of the Nepal Medical Association
Ying Zhang, Mao-nian Zhang
OBJECTIVE: To investigate the factors affecting visual prognosis following indirect traumatic optic neuropathy and to evaluate the effects of medication therapy (steroid mainly) and combined therapy (optic nerve decompression and medications) on the outcome of this injury. METHODS: One hundred and eighty six eyes were retrospectively analyzed in this study. Multiple factors affecting visual prognosis and the comparison of result between these two different kinds of therapy were analyzed statistically...
March 2007: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
Na Li, Nian-kai Zhang, Ying Tian, Min Chen
OBJECTIVE: To review the effects of optic nerve decompression by endoscopic technique in traumatic optic neuropathy. METHODS: Seventy-two patients (73 eyes) with traumatic optic neuropathy which were treated with large dose of glucocorticoid but inefficacious were undergone endoscopic optic nerve decompression. The days from injury to surgery were 1-57 d. Among that, < or = 3 d 15 cases, 4-7 d 37 cases, 8-10 d 9 cases, 11-15 d 5 cases, 16-30 d 5 cases, >30 d 1 cases...
March 2006: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
Lawrence C Hou, Marjorie A Murphy
A 4-year-old boy presented with complete blindness in his left eye after accidentally walking into a merchandise display hook while shopping in a department store. An ophthalmologic examination revealed no light perception, an amaurotic pupil, and nasal conjunctival injection in the eye. Intravenous steroids did not improve his vision.
July 2004: Journal of Pediatric Ophthalmology and Strabismus
Ching-Hua Hsieh, Yur-Ren Kuo, Hsin-Chia Hung, Hui-Hong Tsai, Seng-Feng Jeng
This study evaluated the outcome for 45 consecutive, nonrandomized patients whose indirect type traumatic optic neuropathy and periorbital facial bone fracture were treated at the Chang Gung Memorial Hospital in Kaohsiung between June of 1996 and June of 2001. There were a total of 48 eye injuries in 45 patients (3 patients sustained bilateral eye injuries). Data related to megadose steroid treatment, timing of open reduction and internal fixation for periorbital facial fractures, and pretreatment and post-treatment of visual acuities were collected from the medical records...
April 2004: Journal of Trauma
Wen-Guei Yang, Chien-Tzung Chen, Pei-Kwei Tsay, Glenda H de Villa, Yueh-Ju Tsai, Yu-Ray Chen
This study was performed to identify factors that can affect the final outcome and to recognize the proper management for patients with traumatic optic neuropathy (TON). This retrospective study included 42 consecutive patients with TON after maxillofacial trauma. Megadose methylprednisolone was administered to all patients during the first 3 days after diagnosis. Twenty-four patients received treatment with megadose steroids combined with optic nerve decompression and the remaining 18 with megadose methylprednisolone alone...
January 2004: Annals of Plastic Surgery
B H Wang, B C Robertson, J A Girotto, A Liem, N R Miller, N Iliff, P N Manson
The outcome of traumatic optic neuropathy was evaluated following penetrating and blunt injuries to assess the effect of treatment options, including high-dose steroids, surgical intervention, and observation alone. Factors that affected improvement in visual acuity were identified and quantified. Sixty-one consecutive, nonrandomized patients presenting with visual loss after facial trauma between 1984 and 1996 were assessed for outcome. Pretreatment and posttreatment visual acuities were compared using a standard ophthalmologic conversion from the values of no light perception, light perception, hand motion, finger counting, and 20/800 down to 20/15 to a logarithm of the minimum angle of resolution (log MAR)...
June 2001: Plastic and Reconstructive Surgery
Z Mariak, Z Mariak, I Obuchowska, A Stankiewicz, E Proniewska-Skretek, R Zalewska
The problem of pathogenesis and effective treatment of traumatic optic neuropathy (TON) is still an open question. According to current opinions the immediate results of conservative treatment with megadose corticosteroids are similar to those obtained with surgical decompression. No data on late results of both modes of treatment are at present available. This study was undertaken to assess the late results of conservative treatment of traumatic optic neuropathy. The clinical material comprised 15 patients (3 women and 12 men, age 14-64 years), who developed clinical symptoms of TON as a consequence of closed head trauma...
September 1998: Neurologia i Neurochirurgia Polska
L A Levin, R W Beck, M P Joseph, S Seiff, R Kraker
OBJECTIVE: To compare the visual outcome of traumatic optic neuropathy treated with corticosteroids, treated with optic canal decompression surgery, or observed without treatment. DESIGN: Comparative nonrandomized interventional study with concurrent treatment groups. PARTICIPANTS: A total of 133 patients with traumatic optic neuropathy (127 unilateral and 6 bilateral) who had an initial visual assessment within 3 days of injury. At least 1 month of follow-up was required for inclusion in the primary analysis...
July 1999: Ophthalmology
H Y Chen, R K Tsai, H Z Wang
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...
September 1998: Kaohsiung Journal of Medical Sciences
J M Schmidbauer, E Müller, H Höh, E Robinson
BACKGROUND: Indirect traumatic optic neuropathy represents a severe, potential vision-threatening disease process that requires close interdisciplinary cooperation for treatment. In general, any therapy has been discussed controversially in the literature. Based upon experiences with spinal cord trauma, high-dose steroid therapy is recommended initially to minimize secondary consequences following orbital trauma. The usefulness of surgical decompression of the optic nerve has been confirmed in several studies but is still not recommended in principle...
February 1998: HNO
W E Lieb, J Maurer, W Müller-Forell, W Mann
UNLABELLED: The therapy of traumatic optic neuropathy remains controversial. Some authors recommend observation and others, the use of megadose corticosteroids or surgical decompression of the optic nerve. Improvements in visual acuity from no light perception (NLP) preoperatively to close to normal visual acuities have been reported after transethmoidal decompression and systemic steroids. The transnasal microscopic approach offers safe and effective access to the optic canal. MATERIALS AND METHODS: Retrospectively 15 patients (13 men/2 women) ranging in age from 17 to 67 years, who were surgically decompressed in the Ear-Nose-Throat Department between 1989 and 1994, were analyzed...
April 1996: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
T Fujitani, K Inoue, T Takahashi, K Ikushima, T Asai
From 1968 through 1984, 110 cases (113 eyes) with indirect traumatic optic neuropathy were seen at the Department of Ophthalmology and Otorhinolaryngology of the Kobe University Hospital; 43 eyes were treated nonsurgically with steroid and 70 eyes were operated on by the endonasal-transethmoidal method of optic canal decompression. By comparison of the visual improvements in the two groups, the effectiveness of the surgical treatment was evaluated. In the nonsurgical group, 19 eyes showed a visual improvement, giving an overall improvement rate of 44...
1986: Japanese Journal of Ophthalmology
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