ENDOSCOPIC APPROACH TO TRAUMATIC VISUAL-LOSS

OBJECTIVE: To review our experience with the use of endoscopic optic n erve decompression in traumatic blindness. METHOD: We did a retrospect ive analysis of patients with traumatic blindness that underwent endos copic decompression of the optic canal to determine postoperative visu al acuity and correlate if to preoperative visual loss and intraoperat ive findings. The setting was a Level I university trauma center. We i dentified 8 patients treated with both surgery and steroids over a 10- month period beginning in 1993 (Seven males, one female). RESULTS: Fou r of six patients with total blindness (no light perception) had impro vements in visual acuity, In three patients, visual acuity returned to preinjury levels, One patients with total blindness was operated on 6 weeks after injury and had a visual acuity of 20/800 at 1-year follow -up. Two patients with hand motion preoperatively had improvement in v isual acuity. In one patient, vision returned to normal (20/20), and I n the other it improved to 20/200). Five patients were operated on aft er megadose steroid treatment for at least 48 hours failed; four of fi ve noted dramatic improvements in visual acuity. CONCLUSION: The endos copic approach may be used to successfully decompress the optic nerve in traumatic blindness.