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The data offered in the article by Rajiniganth et al¹ do not support the assertion that patients with traumatic optic neuropathy "must be treated with a combined therapy protocol for a better visual outcome."

The International Optic Nerve Trauma Study (IONTS) represents the largest, most unbiased study of traumatic optic neuropathy to date, and points to far different conclusions.^2-3 The IONTS found no clear benefit for either corticosteroid therapy or optic canal decompression surgery.² While the number of patients was limited, results of the IONTS and a review of the literature provide sufficient evidence to conclude that neither corticosteroid therapy nor optic canal surgery should be considered the standard of care for patients with traumatic optic neuropathy.² It is surprising that the authors attempt to redefine the standard of care for this condition based upon their uncontrolled study.

Rajiniganth et al's study suffers from the same limitation as all previous . . . [Full Text of this Article]

Julian D. Perry, MD

Correspondence: Dr Perry, Division of Ophthalmology, Cleveland Clinic Foundation, Desk I-32, Cleveland, OH 44195 (perryj1@ccf.org).

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