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The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study

moviecapture 添加于 2014-1-12 08:06 | 1573 次阅读 | 0 个评论

作者
Levin LA, Beck RW, Joseph MP, Seiff S, Kraker R
摘要
OBJECTIVE: To compare the visual outcome of traumatic optic neuropathy treated with corticosteroids, treated with optic canal decompression surgery, or observed without treatment. DESIGN: Comparative nonrandomized interventional study with concurrent treatment groups. PARTICIPANTS: A total of 133 patients with traumatic optic neuropathy (127 unilateral and 6 bilateral) who had an initial visual assessment within 3 days of injury. At least 1 month of follow-up was required for inclusion in the primary analysis. INTERVENTIONS: On the basis of treatment received within 7 days of injury, patients with unilateral injuries were categorized as being in one of three treatment groups: untreated (n = 9), corticosteroid (n = 85), or optic canal decompression surgery (n = 33). MAIN OUTCOME MEASURE: Visual acuity. RESULTS: Visual acuity increased by > or = 3 lines in 32% of the surgery group, 57% of the untreated group, and 52% of the steroid group (P = 0.22). The surgery group had more patients whose initial vision was no light perception. After adjustment for the baseline visual acuity, there were no significant differences between any of the treatment groups. There was no indication that the dosage or timing of corticosteroid treatment or the timing of surgery was associated with an increased probability of visual improvement. CONCLUSIONS: No clear benefit was found for either corticosteroid therapy or optic canal decompression surgery. The number of patients studied was sufficient to rule out major effects in the treatment groups, although clinically relevant effects in specific subgroups could have been missed. These results and the existing literature provide sufficient evidence to conclude that neither corticosteroids nor optic canal surgery should be considered the standard of care for patients with traumatic optic neuropathy. It is therefore clinically reasonable to decide to treat or not treat on an individual patient basis.
详细资料
- 关键词: Adult; Decompression, Surgical/*methods; Eye Injuries/etiology/physiopathology/*therapy; Female; Follow-Up Studies; Glucocorticoids/administration & dosage/*therapeutic use; Humans; Male; Methylprednisolone/administration & dosage/*therapeutic use; Optic Nerve Diseases/etiology/physiopathology/*therapy; *Optic Nerve Injuries/physiopathology; Treatment Outcome; Visual Acuity/physiology; World Health
- 文献种类:期刊
- 期刊名称: Ophthalmology
- 期刊缩写: Ophthalmology
- 期卷页: 1999年第106卷第7期 1268-1277页
- 地址: Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, USA
- ISBN: 0161-6420
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