Abstract
Purpose :
To compare clinical outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) and steroid pulse therapy (SPT) for indirect traumatic optic neuropathy (ITON) patients and determine factors of prognostic values.
Methods :
The ITON Patients were enrolled between January 2017 and June 2019. The patients were examined, and six main outcome parameters were measured for analyses and comparisons before and after surgical procedures, including those of visual acuity (VA), oxygen saturation (SO2) of retinal blood vessels using retinal oximeter, visual evoked potential (VEP), intraocular pressure (IOP), axial length (AL), blood pressure (BP).
Results :
No major adverse side-effects were found in all the patients treated with ETOCD surgery. Moreover, VA improvement was seen in higher proportion of patients after ETOCD surgery (76.0%) than those patients who received SPT treatment only (37.5%, p<0.05). Preoperative VA and lag time were two important prognostic factors for outcome assessment; meanwhile, other factors such as age, gender, causes of injuries, side of injury and application of steroid treatment were not statistically correlated with prognosis (p>0.05). Vast majority of patients with preoperative residual vision gained VA improvement (96.6%) after surgery, and it was significantly better than patients with preoperative no light perception (NLP, 47.6%, p<0.001). Among all cases with improved VA, more than 85% eyes were improved within two days after ETOCD surgery. After surgery, the oxygen saturation of retinal arteries (SaO2), veins (SvO2) and the difference of SaO2 and SvO2 (AVD) increased. Moreover, postoperative VEP improved significantly in terms of shorter latency time of N1, N2, P1 (p<0.01), and greater amplitude peak of wave P1 and P2 (p<0.01).
Conclusions :
The ETOCD surgery is an effective and low-risk therapy for the ITON patients compared with SPT treatment. Preoperative VA and lag time were important factors to prognosticate VA improvement after ETOCD surgery. The increase of retinal SO2 by ETOCD may be an underlying principle for postoperative VA improvement.
This is a 2020 ARVO Annual Meeting abstract.