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Traumatic optic neuropathy: visual outcome following combined therapy protocol.

OBJECTIVE
To assess the visual outcome in cases of traumatic optic neuropathy treated with a combined therapy protocol of methylprednisolone injections and endoscopic optic nerve decompression.


DESIGN
Prospective, nonrandomized study.


SETTING
Academic tertiary care referral center.


PATIENTS
The study included 44 patients with posttraumatic indirect optic nerve injury.


MAIN OUTCOME MEASURES
Visual acuity.


RESULTS
Visual improvement was achieved in 31 patients (70%) when treatment was initiated within 7 days of injury, whereas only 10 patients (24%) showed improvement when the treatment was started after more than 7 days. The time lapse after injury and treatment, degree of visual loss, and computed tomographic evidence of canalicular and pericanalicular fractures were found to be significant prognostic factors.


CONCLUSIONS
Endoscopic optic nerve decompression is a minimally invasive procedure that does not cause any adverse cosmetic effects. The risk-benefit ratio suggests that the combined therapy protocol of methylprednisolone injections and endoscopic optic nerve decompression results in a better visual outcome, without any major risks.