Analysis of risk factors for patients with traumatic optic neuropathy and comparison of visual outcomes of management strategies

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Abstract

Background

Traumatic optic neuropathy (TON) is a rare complication of facial trauma that results in vision loss. Clinical diagnosis of TON is based on a history of head trauma and an ophthalmic examination; however, the risk factors for TON and the ideal treatment strategy remain undetermined. This study aimed to identify predictive risk factors for TON and evaluate the effectiveness of current treatments with respect to visual outcomes in patients with TON.

Methods

This study retrospectively enrolled patients with periorbital facial bone fracture between 2008 and 2019. Initial facial bone computed tomography, ophthalmic exam results, initial Glasgow Coma Scale, and Injury Severity Score were recorded. This study classified patients into 4 intervention groups (i.e., medication, surgery, combination therapy, and observation) to compare the outcome of visual acuity.

Results

This study enrolled 1168 patients with facial bone fractures, 93 (7.96%) of whom were diagnosed as having TON. Independent risk factors for TON included optic canal fracture, medial orbital wall fracture, retrobulbar hematoma, and head Abbreviated Injury Scale ≥4. Patients with TON who initially presented with no light perception tended to have poor final visual acuity (VA) outcomes. The results indicated no significant difference in VA improvement among patients receiving observation, megadose corticosteroid therapy, surgical decompression, or combined steroid therapy and decompression.

Conclusion

Clinicians can achieve early prediction of TON in patients with an initial unconscious state and the identified risk factors. The results indicated that the conservative observation yielded noninferior VA outcomes in patients with TON compared with those receiving medication or surgical treatment.
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分析外伤性视神经病变患者的风险因素,比较治疗策略的视觉效果。
背景:创伤性视神经病变(TON)是一种罕见的面部创伤并发症,可导致视力丧失。TON的临床诊断基于头部外伤史和眼科检查;然而,TON的风险因素和理想的治疗策略仍未确定。本研究旨在确定TON的预测性风险因素,并评估当前治疗方法对TON患者视觉效果的影响:本研究回顾性地纳入了2008年至2019年期间眶周面部骨骼骨折的患者。记录初始面骨计算机断层扫描、眼科检查结果、初始格拉斯哥昏迷量表和损伤严重程度评分。该研究将患者分为4个干预组(即药物治疗组、手术治疗组、综合治疗组和观察组),以比较视力结果:本研究共招募了1168名面部骨折患者,其中93人(7.96%)被诊断为TON。TON的独立风险因素包括视管骨折、内侧眶壁骨折、球后血肿和头部简易损伤量表≥4。最初没有光感的TON患者最终视力(VA)往往较差。结果表明,接受观察、大剂量皮质类固醇治疗、手术减压或类固醇治疗和减压联合治疗的患者在视力改善方面没有明显差异:结论:临床医生可以对最初处于昏迷状态并存在已识别风险因素的患者进行 TON 早期预测。结果表明,与接受药物治疗或手术治疗的患者相比,保守观察对 TON 患者的 VA 效果并不差。
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来源期刊
CiteScore
3.10
自引率
11.10%
发文量
578
审稿时长
3.5 months
期刊介绍: JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.
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