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Delayed Optic Nerve Decompression for Indirect Optic Nerve Injury
Author(s) -
Thakar A.,
Mahapatra A. K.,
Tandon D. A.
Publication year - 2003
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200301000-00021
Subject(s) - medicine , visual acuity , surgery , decompression , optic nerve , optic neuropathy , anesthesia , ophthalmology
Objective To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury. Study Design Critical analysis of Proforma‐based, prospectively accrued data of all cases with injury to surgery interval of greater than 2 weeks. Methods Thirty‐five cases with a median injury to surgery interval of 56 days (range, 16–374 d). Surgical decompression was undertaken only in cases that continued to have poor vision after treatment with steroids in conventional doses (1 mg/kg prednisolone). Pre‐ and postoperative visual acuity measurements were converted to the logMAR scale of visual acuity and the percentage of visual improvement was calculated. Results Surgery was universally unrewarding in all 9 cases with persistent and complete blindness of greater than 2 weeks and no response to steroid therapy. Of the cases with some residual vision, 20 of 26 cases improved (mean percentage improvement, 41.0 ± 5.7%). Cases were categorized on the basis of the injury to surgery interval into groups of 2 weeks to 2 months, 2 months to 4 months, and greater than 4 months. No significant difference was demonstrated in the probability or quantum of improvement in these groups ( P = .97). Conclusions Optic nerve decompression remains useful as a salvage procedure for conventional dose steroid failed cases of traumatic optic neuropathy. In cases that are not completely blind, vision can be improved even when surgery is undertaken a few months after the injury.