TRAUMATIC OPTIC NEUROPATHY - A METAANALYSIS

Background: The management of traumatic optic neuropathy remains contr oversial. Reports of improvement have been published after observation alone, treatment with corticosteroids, and surgical decompression. Ob jective: To systematically review the published literature about traum atic optic neuropathy using a meta-analysis. Methods: We performed a r etrospective literature review of case series and case reports of trau matic optic neuropathy. These include all English language cases and s elected non-English language cases for which patient data were availab le. The cases were organized into four grades based on visual acuity a nd the locations and type of fracture. Grade 1 included patients with visual acuity greater than 20/200 in the affected eye and without a po sterior orbit fracture; grade 2, patients with visual acuity between 2 0/200 and light perception; grade 3, patients without light perception or with a nondisplaced posterior orbital fracture and remaining visio n; and grade 4, patients with no light perception and a displaced post erior orbital fracture. A meta-analysis was performed, analyzing for e ach case the recovery of visual acuity for treatment, fracture pattern , and grade. Results: The recovery of vision in treated patients was s ignificantly better than the recovery in patients receiving no treatme nt. No significant difference in improvement was found among patients treated with corticosteroids alone, with surgical decompression alone, or with corticosteroids and surgical decompression. Recovery was rela ted to the severity of initial injury, as reflected in the grading sys tem. A trend was noted for better improvement of visual acuity in pati ents without orbital fractures than those with orbital fractures, and also in patients with anterior orbital fractures than in patients with posterior orbital fractures. Conclusions: Treatment with corticostero ids, extracranial decompression, or both, is better than no treatment of traumatic optic neuropathy. Because the data are insufficient Co de termine whether corticosteroids, surgery, or use of both treatments is most effective, the findings of the ongoing International Optic Nerve Trauma Study should prove valuable. The standardized grading system w e developed is a useful tool for comparing studies and treatment proto cols.