OPTIC CANAL DECOMPRESSION IN INDIRECT OPTIC-NERVE TRAUMA

Background: The proper management of neurogenic visual loss after blun t head trauma is controversial. Non-treatment, corticosteroids, and su rgical decompression of the optic canal are all currently considered t o be reasonable alternatives. The goal of this study was to identify f actors affecting improvement in patients treated with canal decompress ion. Methods: A retrospective analysis of 31 cases in which transethmo idal decompression of the optic canal had been performed for neurogeni c visual loss after closed head trauma was conducted. Each patient was alert and free of injury to the globe when evaluated before surgery. Surgery was performed within 6 days of injury, and all were given peri operative steroids. Results: Visual acuity improved in 22 (71%) patien ts, with 6 (19%) regaining visual acuity of 20/40 or better. The mean improvement from preoperative visual deficit was 42.0% +/- 6.6%, with a median improvement of 45.2%. Both univariate and multivariate analys is suggested that vision improved more in patients who were younger th an 40 years of age than in patients who were 40 years of age or older. Interval between injury and surgery, preoperative visual acuity, and the presence of optic canal fracture did not affect outcome. Conclusio n: Any future randomized trials of therapy should stratify patients ba sed on age. Enrollment of patients with no light perception or who exp erienced delay between injury and treatment may be reasonably consider ed.