{"title":"Clinical features, management, and prognosis factors of traumatic optic neuropathy.","authors":"Meiqian He, Zuyi Yang, Zhengming Shi, Youxin Chen, Xinyu Zhao","doi":"10.1016/j.survophthal.2025.07.012","DOIUrl":null,"url":null,"abstract":"<p><p>We provide a comprehensive clarification of the demographics, clinical features, management, prognostic factors, and complications of traumatic optic neuropathy (TON). About 6068 patients from 109 studies were included. The pooling results indicated that TON was male-dominated (84 %) with road traffic accidents as the leading cause (67 %). After trauma, 46 % of cases had no light perception (NLP), and the most frequent associated injury was craniofacial fractures (70 %). Optic canal fractures (OCF) were detected in 34 % of cases via computed tomography and in 47 % intraoperatively. The general visual improvement rate of conservative treatment, steroid pulse therapy (SPT), optic nerve decompression (OND) and intravenous erythropoietin injection were 34 %, 48 %, 56 %, and 61 %, respectively. OND and SPT showed similar efficacy in patients with both NLP (37 % vs. 28 %) and residual vision (76 % vs. 73 %), but were superior to observation only in patients with residual vision. Patients without OCF also responded similarly to OND (57 %) and SPT (62 %), whereas those with OCF showed a higher response rate to OND (53 %) compared to SPT (24 %). Early intervention (within 7 days post-trauma) improved outcomes for both OND and SPT. Complications from OND were rare. TON mainly affects males, causes severe vision impairment, and is often associated with craniofacial fractures. OND may provide greater benefit than SPT for patients with OCF, while both treatments appear similarly effective for those without OCF, regardless of baseline vision status; however, heterogeneity in the definition and diagnostic criteria of TON, as well as variability in study designs, warrants cautious interpretation of these findings.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Survey of ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.survophthal.2025.07.012","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
We provide a comprehensive clarification of the demographics, clinical features, management, prognostic factors, and complications of traumatic optic neuropathy (TON). About 6068 patients from 109 studies were included. The pooling results indicated that TON was male-dominated (84 %) with road traffic accidents as the leading cause (67 %). After trauma, 46 % of cases had no light perception (NLP), and the most frequent associated injury was craniofacial fractures (70 %). Optic canal fractures (OCF) were detected in 34 % of cases via computed tomography and in 47 % intraoperatively. The general visual improvement rate of conservative treatment, steroid pulse therapy (SPT), optic nerve decompression (OND) and intravenous erythropoietin injection were 34 %, 48 %, 56 %, and 61 %, respectively. OND and SPT showed similar efficacy in patients with both NLP (37 % vs. 28 %) and residual vision (76 % vs. 73 %), but were superior to observation only in patients with residual vision. Patients without OCF also responded similarly to OND (57 %) and SPT (62 %), whereas those with OCF showed a higher response rate to OND (53 %) compared to SPT (24 %). Early intervention (within 7 days post-trauma) improved outcomes for both OND and SPT. Complications from OND were rare. TON mainly affects males, causes severe vision impairment, and is often associated with craniofacial fractures. OND may provide greater benefit than SPT for patients with OCF, while both treatments appear similarly effective for those without OCF, regardless of baseline vision status; however, heterogeneity in the definition and diagnostic criteria of TON, as well as variability in study designs, warrants cautious interpretation of these findings.
我们提供了一个全面的人口统计,临床特点,管理,预后因素和并发症的创伤性视神经病变(TON)的澄清。来自109项研究的约6068名患者被纳入研究。汇总结果显示,TON以男性为主(84%),道路交通事故是主要原因(67%)。创伤后,46%的病例没有光知觉(NLP),最常见的相关损伤是颅面骨折(70%)。术中视神经管骨折(OCF)的检出率为47%,计算机断层扫描检出率为34%。保守治疗、类固醇脉冲治疗(SPT)、视神经减压(OND)和静脉注射促红细胞生成素的总体视力改善率分别为34%、48%、56%和61%。OND和SPT对NLP患者(37% vs. 28%)和残视力患者(76% vs. 73%)的疗效相似,但优于仅对残视力患者进行观察。没有OCF的患者对OND(57%)和SPT(62%)也有类似的反应,而OCF患者对OND(53%)的反应率高于SPT(24%)。早期干预(创伤后7天内)改善了OND和SPT的预后。OND的并发症很少见。TON主要影响男性,导致严重的视力障碍,并常伴有颅面骨折。对于有OCF的患者,OND可能比SPT提供更大的益处,而对于没有OCF的患者,无论基线视力状况如何,两种治疗似乎同样有效;然而,由于TON的定义和诊断标准的异质性以及研究设计的可变性,需要对这些发现进行谨慎的解释。
期刊介绍:
Survey of Ophthalmology is a clinically oriented review journal designed to keep ophthalmologists up to date. Comprehensive major review articles, written by experts and stringently refereed, integrate the literature on subjects selected for their clinical importance. Survey also includes feature articles, section reviews, book reviews, and abstracts.