School of Medicine and Health Sciences Poster Presentations

Title

Treatment Outcomes following Traumatic Optic Neuropathy

Poster Number

176

Document Type

Poster

Keywords

Blindness--therapy; Optic Nerve Injuries--diagnosis; Optic Nerve Injuries--therapy

Publication Date

3-2016

Abstract

Introduction: An association between facial trauma and blindness has long been recognized,1 but it was not until 1845 that Nuhn recognized that visual impairment was associated with optic nerve scarring. Traumatic optic neuropathy can be either direct or indirect. Direct traumatic optic neuropathy results from anatomical disruption of the optic nerve, whereas indirect traumatic optic neuropathy is caused by the transmission of forces from a site distant from the optic nerve.2 The occurrence of traumatic optic neuropathy is 0.4 to 2.5 percent in facial trauma,2–5 which has limited large-scale investigations. Nevertheless, a comprehensive understanding of orbital frac- ture patterns,1,6,7 load-bearing,8 and mechanistic skeletal impact studies9 has elucidated that the mechanistic processes leading to traumatic optic.

Background: Traumatic optic neuropathy is characterized by sudden loss of vision following facial trauma leading to variable visual de cits. The purpose of this study was to evaluate recent institutional trends in the treatment of traumatic optic neuropathy, evaluate the outcomes of different treatment strat- egies, 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). Man- agement 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 per- cent 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 un- likely 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 admin- istration and observation are comparable. (Plast. Reconstr. Surg. 137: 231, 2016.)

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

1

Comments

Presented at: GW Research Days 2016

Also Published in:

Treatment Outcomes following Traumatic Optic Neuropathy Sosin, Michael M.D. [et als.] (2016). Plastic and Reconstructive Surgery, 137(1):231-8. DOI: 10.1097/PRS.0000000000001907

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Treatment Outcomes following Traumatic Optic Neuropathy

Introduction: An association between facial trauma and blindness has long been recognized,1 but it was not until 1845 that Nuhn recognized that visual impairment was associated with optic nerve scarring. Traumatic optic neuropathy can be either direct or indirect. Direct traumatic optic neuropathy results from anatomical disruption of the optic nerve, whereas indirect traumatic optic neuropathy is caused by the transmission of forces from a site distant from the optic nerve.2 The occurrence of traumatic optic neuropathy is 0.4 to 2.5 percent in facial trauma,2–5 which has limited large-scale investigations. Nevertheless, a comprehensive understanding of orbital frac- ture patterns,1,6,7 load-bearing,8 and mechanistic skeletal impact studies9 has elucidated that the mechanistic processes leading to traumatic optic.

Background: Traumatic optic neuropathy is characterized by sudden loss of vision following facial trauma leading to variable visual de cits. The purpose of this study was to evaluate recent institutional trends in the treatment of traumatic optic neuropathy, evaluate the outcomes of different treatment strat- egies, 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). Man- agement 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 per- cent 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 un- likely 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 admin- istration and observation are comparable. (Plast. Reconstr. Surg. 137: 231, 2016.)