title: The effect of steroids in combination with optic nerve decompression surgery in traumatic optic neuropathy.
abstract: OBJECTIVE
  Traumatic optic neuropathy (TON) is an important cause of severe visual impairment following blunt or penetrating head trauma. Treatment options include steroids, decompression, or both. Studies have failed to show a clear benefit for either steroids or surgery or a combined therapy. This study describes the visual outcome in surgically managed patients with or without steroid treatment.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  In a retrospective chart review we included patients (n = 42) with TON who were managed with optic nerve decompression surgery with or without steroids. Comparison of initial and final visual acuity was the primary outcome parameter.
  
  
  RESULTS
  In 42 consecutive patients, steroids were used in 21 cases (50%). Ten patients received a high-dose systemic regimen of more than 500 mg methylprednisolone initial dose, and 11 patients were treated with a lower dose. The overall visual improvement rate was 33%, no change was noted in 50%, and no outcome data were available in 17%. The visual improvement rate of patients treated with decompression surgery and steroids was lower (29%, 6 of 21) than those treated with surgery alone (53%, 8 of 15). Comparing both groups, additional steroids had no beneficial effect on the visual outcome (P = .97). There was no case with a deterioration of visual function due to therapy.
  
  
  CONCLUSIONS
  In patients with traumatic optic neuropathy who were treated with optic nerve decompression surgery, steroids had no beneficial effect on the visual outcome.
  
  
  METHODS
  2c.
authors.affiliation: Department of Otorhinolaryngology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Ropposch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Steger
authors.forename: Cem
authors.initials: C
authors.lastname: Meço
authors.forename: Martin
authors.initials: M
authors.lastname: Emesz
authors.forename: Herbert
authors.initials: H
authors.lastname: Reitsamer
authors.forename: Gerd
authors.initials: G
authors.lastname: Rasp
authors.forename: Gerhard
authors.initials: G
authors.lastname: Moser
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009900:Optic Nerve / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D020221:Optic Nerve Injuries / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone