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E. E. Moscato, O. Nyong'o, A. Amadi; Comparison of Visual Acuities Between Megadose Steroid Treated versus Non-Steroid Treated Patients With Indirect Traumatic Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2479.
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To evaluate and compare visual acuity outcomes among patients with traumatic optic neuropathy treated with and without intravenous megadose corticosteroids.
After obtaining Institutional Review Board approval, we performed a case-control retrospective review of all patients diagnosed with traumatic optic neuropathy (TON) from January 2003 through May 2006. TON was diagnosed in the presence of a unilateral relative afferent pupillary defect in the setting of craniofacial trauma. Charts were reviewed for mechanism of injury, steroid treatment and dosage if any, serial visual acuities, presence of canal fractures, Ishihara’s color plates, visual fields, and visual evoked potentials when available. As per our protocol, methylprednisolone was given to TON patients with a loading dose of 30 mg/kg followed by a continuous infusion of 5.4 mg/kg/hr for 24 to 48 hours unless contraindicated.
52 patients (52 eyes) were diagnosed with TON. Two patients with direct injuries to the optic nerve from bony fragments in the optic canal were excluded. The mean patient age was 38.9 years. Thirty-eight of 50 patients with indirect TON had a visual acuity (VA) measurement at some interval during the hospital course. Of these 38 patients, 30 were treated with megadose steroids as per our protocol. Among the 30 treated patients, 20% had final VA of NLP or LP. Average VA better than LP in treated patients was 20/126. Out of 8 untreated patients, 50% had final VA of NLP or LP. Average final VA better than LP in untreated patients was 20/159. Only 37.5% of untreated patients compared with 53.3% of treated patients had a final VA equal to or better than 20/100. Visual acuity at initial presentation of TON was obtained in 19 of 50 patients. Fifteen of the 19 were treated with megadose corticosteroids. Among this treated group, 73.3% demonstrated improved final VA, 20% showed no change, and 6.67% had a decline in VA. In the untreated group with initial visual assessment, no patients showed improvement in final VA, 75% had no change, and 24% had a decline in VA. Forty percent of the treated group versus 25% of the untreated group had final VA equal to or better than 20/100.
On average, patients with indirect traumatic optic neuropathy who were treated with megadose steroids had better final visual acuity outcomes. This suggests a beneficial effect of treatment with megadose corticosteroids. Future studies including multi-center prospective trials are needed in order to further assess the value of treatment with corticosteroids and compare visual outcomes among treated and untreated patients.
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