Delayed optic nerve decompression for indirect optic nerve injury.
OBJECTIVE
To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury.


METHODS
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.
Thakar
A
A
Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi. meenaal@ndb.vsnl.net.in
Mahapatra
A K
AK
Tandon
D A
DA
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001766:Blindness / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D020221:Optic Nerve Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011336:Probability; D011446:Prospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity