title: Treatment Outcomes following Traumatic Optic Neuropathy.
abstract: BACKGROUND
  Traumatic optic neuropathy is characterized by sudden loss of vision following facial trauma leading to variable visual deficits. The purpose of this study was to evaluate recent institutional trends in the treatment of traumatic optic neuropathy, evaluate the outcomes of different treatment strategies, and identify factors associated with improved vision.
  
  
  METHODS
  Institutional review board approval was obtained to retrospectively review patients diagnosed with traumatic optic neuropathy at a high-volume trauma center from 2004 to 2012. Pretreatment and posttreatment visual acuity was compared using quantitative analysis of standard ophthalmologic conversion.
  
  
  RESULTS
  A total of 109 patients met inclusion criteria (74.3 percent male patients), with a mean age of 38.0 ± 17.5 years (range, 8 to 82 years). Management of traumatic optic neuropathy involved intravenous corticosteroids alone in 8.3 percent of patients (n = 9), 56.9 percent (n = 62) underwent observation, 28.4 percent (n = 31) had surgical intervention, and 6.4 percent (n = 7) underwent surgery and corticosteroid administration. Only 19.3 percent of patients returned for follow-up. Vision improved in 47.6 percent of patients, with a mean follow-up of 12.9 weeks. Patients younger than 50 years had a trend toward higher rates of visual improvement, 60 percent versus 16.7 percent (p = 0.15).
  
  
  CONCLUSIONS
  The majority of traumatic optic neuropathy patients are unlikely to return for a follow-up examination. Optic nerve decompression has fallen out of favor in the authors' institution, and observation is the most common management strategy. Outcomes following corticosteroid administration and observation are comparable.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Baltimore, Md.; New York, N.Y.; and Washington, D.C. From the Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; the Department of Plastic Surgery, New York University Langone Medical Center; and the George Washington University School of Medicine and Health Sciences.
authors.forename: Michael
authors.initials: M
authors.lastname: Sosin
authors.forename: Carla
authors.initials: C
authors.lastname: De La Cruz
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: Sean Y
authors.initials: SY
authors.lastname: Saadat
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Nam
authors.forename: Paul N
authors.initials: PN
authors.lastname: Manson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Christy
authors.forename: Branko
authors.initials: B
authors.lastname: Bojovic
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001766:Blindness / Q000209:etiology / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis; D019299:Decompression, Surgical / Q000379:methods; D005151:Facial Injuries / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019370:Observation / Q000379:methods; D020221:Optic Nerve Injuries / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones