Optic nerve sheath diameter in the prognosis of patients with traumatic optic neuropathy: Evaluation and predictive efficacy.

Abstract

The purpose of this study was to evaluate and predict visual prognosis in patients with traumatic optic neuropathy by measuring the optic nerve sheath diameter (ONSD). This study included patients diagnosed with traumatic optic neuropathy at a single center between September 1, 2023, and October 1, 2024. Data collection and ONSD measurements were performed before starting treatment. ONSD was measured at 3, 5, 10, and 15 mm (ONSD3, 5, 10, and 15, respectively) behind the globe using computed tomography scanning. The t-test, Mann-Whitney U test, and chi-squared test were used to compare the significance of each variable. Receiver operating characteristic curves and decision curve analysis were used to evaluate predictive efficacy. Of the 22 patients included, treatment was effective for 14 and ineffective for 8. ONSD3 (but not the other ONSD distances) was significantly lower in the effective-treatment group than in the ineffective-treatment group (p < 0.05). ONSD3 achieved the highest area under the curve (AUC, 0.893; 95% confidence interval [CI], 0.739-1.000) for predicting prognosis. Good visual recovery was more likely in patients with ONSD3 ≤5.07 mm (sensitivity, 100%; specificity, 85.7%). Initial visual acuity (VA) differed significantly between the two groups (p < 0.05). ONSD3 and initial VA in combination improved predictive efficacy (AUC, 0.929; 95% CI: 0.818-1.000). Based on our decision curve analysis results, considering both these variables could provide benefits to patients with traumatic optic neuropathy. ONSD3 thus represents a potentially important and novel index for evaluating and predicting visual prognosis in traumatic optic neuropathy.