Endoscopically assisted transconjunctival decompression of traumatic optic neuropathy.
Traumatic optic neuropathy (TON) is a severe sequel after maxillofacial trauma. Recent clinical experience has suggested that optic canal decompression is beneficial in the treatment of TON. With the advent of endoscopy in orbital reconstruction, we extended this technique to decompress the optical canal and reported its outcome. This technique was applied to 30 patients with TON who did not improve after corticosteroids treatment. The average age of the patients at the time of injury was 26 years. Nine patients presented preoperative vision of light perception (LP) or better and 21 patients had no light perception (NLP). Surgery was performed within 1 week of injury in 10 patients, between 1 and 2 weeks in another 10 patients, and between 2 and 4 weeks in the last 10 patients. Thirteen patients were found to have optic canal fractures during surgery. The average follow-up time was 9.5 months. Vision improved in 12 patients including 6 patients (28.6%) with NLP and in 6 patients (66.7%) with LP or better. The improvement degree of visual acuity was 50% in average. Only patient age reflected differences in improvement of visual acuity when analyzing the effect of optic canal fracture, timing of surgery and initial visual acuity. Two patients experienced postoperative cerebrospinal fluid leakage due to associated skull base fractures. The endoscope-assisted transconjunctival technique successfully decompresses the optic canal and improves visual acuity with minimal morbidity. Younger patients had a significantly better visual outcome.
Chen
Chien-Tzung
CT
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Institute of Technology, Chang Gung University, College of Medicine, Taoyuan, Taiwan. ctchenap@adm.cgmh.org.tw
Huang
Faye
F
Tsay
Pei-kwei
PK
Tsai
Yueh-Ju
YJ
Lin
Chih-Hung
CH
Chen
Yi-Chieh
YC
Chen
Yu-Ray
YR
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020221:Optic Nerve Injuries / Q000601:surgery*; D018709:Statistics, Nonparametric