 |
|
Traumatic Optic NeuropathyA Meta-analysis
Matthew W. Cook;
Leonard A. Levin, MD, PhD;
Michael P. Joseph, MD;
Eric F. Pinczower, MD
Arch Otolaryngol Head Neck Surg. 1996;122(4):389-392.
Abstract
| |
Background
The management of traumatic optic neuropathy remains controversial. Reports of improvement have been published after observation alone, treatment with corticosteroids, and surgical decompression.
Objective
To systematically review the published literature about traumatic optic neuropathy using a meta-analysis.
Methods
We performed a retrospective literature review of case series and case reports of traumatic optic neuropathy. These include all English language cases and selected non-English language cases for which patient data were available. The cases were organized into four grades based on visual acuity and the locations and type of fracture. Grade 1 included patients with visual acuity greater than 20/200 in the affected eye and without a posterior orbit fracture; grade 2, patients with visual acuity between 20/200 and light perception; grade 3, patients without light perception or with a nondisplaced posterior orbital fracture and remaining vision; and grade 4, patients with no light perception and a displaced posterior orbital fracture. A meta-analysis was performed, analyzing for each case the recovery of visual acuity for treatment, fracture pattern, and grade.
Results
The recovery of vision in treated patients was significantly better than the recovery in patients receiving no treatment. No significant difference in improvement was found among patients treated with corticosteroids alone, with surgical decompression alone, or with corticosteroids and surgical decompression. Recovery was related to the severity of initial injury, as reflected in the grading system. A trend was noted for better improvement of visual acuity in patients without orbital fractures than those with orbital fractures, and also in patients with anterior orbital fractures than in patients with posterior orbital fractures.
Conclusions
Treatment with corticosteroids, extracranial decompression, or both, is better than no treatment of traumatic optic neuropathy. Because the data are insufficient to determine whether corticosteroids, surgery, or use of both treatments is most effective, the findings of the ongoing International Optic Nerve Trauma Study should prove valuable. The standardized grading system we developed is a useful tool for comparing studies and treatment protocols.
(Arch Otolaryngol Head Neck Surg. 1996;122:389-392)
Author Affiliations
From the Department of Otolaryngology–Head and Neck Surgery, University of Washington Medical Center, Seattle (Mr Cook and Dr Pinczower); the Department of Ophthalmology, University Hospital Clinics, Madison, Wis (Dr Levin); and the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston (Dr Joseph).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Endoscopic Optic Nerve Decompression for Nontraumatic Optic Neuropathy
Pletcher and Metson
Arch Otolaryngol Head Neck Surg 2007;133:780-783.
ABSTRACT
| FULL TEXT
Visual risks of facial fracture repair in the setting of traumatic optic neuropathy.
Shibuya et al.
Arch Otolaryngol Head Neck Surg 2006;132:258-264.
ABSTRACT
| FULL TEXT
Visual prognosis after indirect traumatic optic neuropathy
Carta et al.
J. Neurol. Neurosurg. Psychiatry 2003;74:246-248.
ABSTRACT
| FULL TEXT
Meta-analysis in Otolaryngology
Alsarraf et al.
Arch Otolaryngol Head Neck Surg 2000;126:711-716.
ABSTRACT
| FULL TEXT
Optic Nerve Decompression for Compressive Neuropathy Secondary to Neoplasia
Li et al.
Arch Otolaryngol Head Neck Surg 1997;123:425-429.
ABSTRACT
|
