CLINICAL-EXPERIENCES IN THE MANAGEMENT OF TRAUMATIC OPTIC NEUROPATHY

This study describes 58 cases of sudden visual loss following blunt he ad injury seen from October 1986 to February 1992 at the Tri-Service G eneral Hospital, Taiwan. Twenty-three patients (the medical group) wer e treated with intravenous dexamethasone or oral prednisolone; 25 pati ents (the surgical group) underwent optic canal decompression in addit ion to medical treatment. Ten cases were carefully monitored without a ny kind of treatment; these patients served as controls. None of the c ontrol patients showed any improvement in visual acuity. Thirteen of t he 23 cases (57%) in the medical group had visual improvement (P=0.002 ), while 15 of 25 cases (60%) in the surgical group had visual improve ment (P=0.0002). Patients with vision better than light perception imm ediately after the trauma benefitted more from treatment than did the patients with complete visual loss (73% vs 25% improved in the medical group; 80% vs 55% improved in the surgical group). Twelve of the 58 c ases (21%) had a fracture of the medial wall of the optic canal, as se en by computed tomographic scan. Such optic canal fracture was correla ted with poor visual acuity and poor prognosis. Of these It cases, eig ht presented with complete visual loss, while the other four presented with less than counting fingers; the best corrected vision after trea tment in these patients remained less than 20/200.