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Hidetoshi Onda, Junichiro Kizaki, Hideaki Okawada, Haruo Takahashi, Eiji Tomoyori, Makiko Hirosawa; Therapeutic Outcomes of Traumatic Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6221.
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To investigate the outcomes of transethmoidal decompression of the optic nerve in patients with traumatic optic neuropathy whose visual acuity did not improve with steroid pulse therapy (SPT).
In total, 24 eyes of 24 patients, who were treated for traumatic optic neuropathy between 2006 and 2012 at Showa university hospital, Tokyo, Japan, were analyzed. We performed surgery in patients who did not respond to the treatment with sodium methylprednisolone succinate (1000 mg) for 3 days. The therapeutic response of visual acuity was evaluated using Fukado’s classification 1). Good response was defined as an increase in visual acuity by 2 steps or more. A change in visual acuity was represented by the logarithm of the minimum angle of resolution (log MAR). Visual acuity less than 0.01 was converted to log MAR according to the report by Schulze-Bonsel et al 2). 1) Fukado Y :Results in 400 cases of surgical decompression of the optic nerve.Mod Probl Ophthalmol. 1975;14:474-81. 2) Schulze-Bonsel K, et al: Visual acui- ties “hand motion” and “counting fingers” can be quantified with the freiburg visual acuity test. Invest Ophthalmol Vis Sci 47 (3): 1236-1240, 2006.
Nineteen eyes showed improvement in visual acuity. Of them, 8 eyes were treated with SPT and 11 eyes with SPT plus surgery. The mean times from injury to SPT initiation and from injury to surgery were 3.5 days and 5.8 days, respectively. The mean log MAR values at the first visit and at the end of treatment were 1.41 and 0.28, respectively, with SPT, and 1.85 and 0.90, respectively, with SPT plus surgery. Five eyes showed no improvement, and all of them underwent SPT and surgery. The mean times from injury to SPT initiation and from injury to surgery were 3.5 days and 11 days, respectively. Their mean log MAR values at the first visit and at the end of treatment were the same (2.62).
Optic nerve decompression is effective in patients who do not show improvement in visual acuity with SPT.
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