Abstract
Abstract: :
Purpose: Visual outcomes in cases of traumatic optic neuropathy (TON) were compared, based on subgroup analysis, including degree of initial visual loss, severity of injury, and time until initiation of steroid treatment. Methods: A retrospective chart review was conducted of TON patients treated by one neuro–ophthalmologist (LF) from 1990 to present. TON was defined by the presence of traumatic injury causing visual loss, and if monocular, an associated afferent pupillary defect. Data collected included visual acuity at initial exam and follow–up, level of consciousness after injury, time and type of treatment intervention, and associated radiographic findings. Exclusion criteria included patients under the age of 12, those who never regained consciousness, and patients who had optic nerve avulsions or additional evidence of trauma to explain visual loss (e.g., maculopathy, vitreous hemorrhage). Results: 32 patients were followed a mean of 36 days. 12 patients (38%) had at least one line of visual improvement from initial exam. 11 of these patients presented with HM vision or better. 1 patient presenting with NLP vision had visual improvement to 10/400. 3 of 15 patients with loss of consciousness (LOC) after injury had improvement of vision from initial exam (20%) compared with 9 of 17 patients without LOC (52%). Average improvement of patients with LOC was 2.6 lines of vision compared with 4.5 lines for patients without LOC. High dose intravenous steroids were used in 26 patients. Of the 6 patients who were not treated with steroids, 3 patients had improvement by at least one line of vision. In 20 patients, steroids were initiated within 36 hours of injury, and 8 of these patients had at least one line of visual improvement. 6 patients had steroid treatment started 36 hours after injury, and of these, 2 had at least one line of visual improvement. Conclusion: In patients with TON certain subgroups appear to have a worse prognosis. Degree of visual impairment on initial presentation predicts likelihood of visual improvement. LP vision or worse had a poorer outcome compared to HM vision or better. Severity of injury as manifested by LOC was correlated with a lesser frequency and extent of visual recovery. Visual improvement was seen in patients who received steroids and those who did not. Time to initiation of steroid treatment did not appear to significantly affect outcome, however, a larger sample size may be needed for statistical significance. Although each case must be considered individually these findings may help to guide therapy.
Keywords: trauma • neuro–ophthalmology: diagnosis