title: Traumatic optic neuropathy: facial CT findings affecting visual acuity.
abstract: The purpose of this study was to determine the relationship between admission visual acuity (VA) and facial computed tomographic (CT) findings of traumatic optic neuropathy (TON). We retrospectively evaluated CT findings in 44 patients with TON. Mid-facial fractures, extraconal and intraconal hematomas, hematomas along the optic nerve and the posterior globe, optic canal fracture, nerve impingement by optic canal fracture fragment, and extraconal and intraconal emphysema were evaluated. CT variables of patients with and without available VA were compared. VA was converted into logarithm of the minimum angle of resolution (logMAR) to provide a numeric scale for the purpose of statistical analysis. The risk factors related to poor VA on univariate analysis were as follows: intraconal hematoma [median logMAR -4.7 versus -1.15, p = 0.016] and hematoma along the optic nerve [median -4.7 versus -1.3, p = 0.029]. Intraconal hematoma was the best predictor of poor VA (coefficient, 1.01; SE, 0.34; and p = 0.008). Receiver operating characteristic (ROC) curve analysis showed that the presence of intraconal hematoma and hematoma along the optic nerve predicted poor VA (logMAR of -3.7 or lower) with an area under the curve of 0.8 and 0.85, respectively. TON patients at higher risk of severe visual impairment may be identified based on admission facial CT.
authors.affiliation: Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
authors.forename: Ramachandra P
authors.initials: RP
authors.lastname: Reddy
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Bodanapally
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.forename: Giulia
authors.initials: G
authors.lastname: Van der Byl
authors.forename: David
authors.initials: D
authors.lastname: Dreizin
authors.forename: Lee
authors.initials: L
authors.lastname: Katzman
authors.forename: Robert Kang
authors.initials: RK
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020221:Optic Nerve Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000209:etiology
chemical_list: D003287:Contrast Media