[Treatment and visual prognosis of indirect traumatic optic neuropathy].

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.

RESULTS: Among the 186 eyes, vision acuity was improved in 67 eyes (36.02%) and 51 eyes retrieved central vision. The ratio of vision acuity improvement was 25.74% in 136 NLP (no light perception) eyes after the injury, which was 42.26% lower than that of eyes with residual vision after the injury (P < 0.01). There was significant statistical difference in results between combined therapy and medication therapy. Logistic analysis confirmed that visual prognosis of surgery was better in the eyes with residual vision than that in NLP eyes (P < 0.01). For eyes with residual vision, optic nerve canal fracture, craniocerebral injury, old age and the delay of the first sign to show vision acuity improvement were risk factors for poor prognosis. Early surgical treatment after trauma could protect vision in indirect traumatic optic neuropathy. Post-traumatic vision was a protective factor which was linear correlated with final vision and vision improvement.

CONCLUSIONS: NLP, coma, optic nerve canal fracture, brain injury, old age and delay of vision recovery are risk factors following indirect traumatic optic neuropathy. Therapeutic effect of optic nerve decompression combined with medication on visual acuity is better than that of medication therapy alone.