Role of delayed wider endoscopic optic decompression for traumatic optic neuropathy: a single-center surgical experience

The Clinical Features and Surgical Outcomes of Traumatic Optic Neuropathy in Pediatric Patients

This study aimed to examine the clinical features and assess the surgical outcomes of traumatic optic neuropathy in pediatric patients. A retrospective analysis was conducted on the clinical data of 15 cases (17 eyes) of traumatic optic neuropathy in pediatric patients aged 1 to 6 years between January 2015 and July 2024. Two of them presented with binocular trauma, resulting in a total of 17 affected eyes. The injuries were attributed to various causes: 4 cases resulted from falls, 5 from car accidents, and 6 from localized impact trauma. Of the 15 patients (17 eyes), 10 patients (12 eyes) demonstrated postoperative improvement. Preoperatively, 3 eyes had residual vision, all of which revealed improvement following surgery. Among the 14 eyes with no light perception, 9 exhibited postoperative improvement. In one case (1 eye), where the interval between trauma and surgery was within 7 days, treatment was effective postoperatively. In 14 cases (16 eyes), where the interval exceeded 7 days, 11 eyes revealed postoperative improvement. Radiologic examination revealed optic canal fractures or optic nerve swelling in 6 cases. All patients underwent surgical intervention: 1 patient (1 eye) underwent transnasal endoscopic left orbital apex decompression combined with left periorbital hematoma evacuation, while 14 patients (16 eyes) underwent transnasal endoscopic optic nerve decompression. Imaging assessments should be integrated into the diagnostic process to help in selecting the most appropriate surgical approach for pediatric patients with traumatic optic neuropathy. Transnasal endoscopic optic nerve decompression significantly enhances the prognosis in these cases.

Feasibility of navigation-assisted endoscopic transnasal optic nerve decompression for the treatment of traumatic optic neuropathy in patients with midfacial fractures

Objectives

Traumatic optic neuropathy (TON), a relatively rare condition, can cause visual functional impairment and permanent functional damage. Surgeons should be familiar with its diagnostic criteria and treatment to effectively manage cases of facial trauma with TON. We investigated the feasibility of navigation-assisted endoscopic trans-nasal optic nerve decompression (ETOND) to treat TON in maxillofacial trauma patients. Patients and.

Methods

We retrospectively analyzed data from the clinical investigation of four consecutive patients, two males and two females with an average age of 75 years, with midfacial fractures and TON between April 2021 and September 2023. All patients had swelling and subcutaneous periorbital hemorrhage accompanied by optic nerve canal and zygomaticomaxillary complex fractures on the affected side. Three patients had lacerations on the lateral eyebrow or upper eyelid. All patients were evaluated by an ophthalmologist for visual impairment; two patients could see hand motion at a 30 cm distance, one patient could perceive light, and one did not have any loss of visual acuity. Among the four patients, three had visual impairment immediately after the injury, and one showed delayed impairment.

Results

The patients were treated with navigation-assisted ETOND conducted by an endoscopic rhinologist. Three of the ETONDs were performed along with open reduction and internal fixation (ORIF); the other ETOND was delayed. Orbital reconstruction was performed in three patients. Steroid therapy was administered to two patients, one pre-operatively and one post-operatively. The two patients with pre-operative vision loss showed improved visual acuity post-operatively, and the two patients with no pre-operative visual impairment had no vision loss associated with ORIF for their midfacial fractures. No patient had post-operative complications.

Conclusion

Navigation-assisted ETOND can be performed easily by endoscopic rhinologists; and prompt examination, diagnosis, and treatment are important in patients with facial trauma and TON.

Vision improvement in indirect traumatic optic neuropathy treated by endoscopic transnasal optic canal decompression

BACKGROUND

Indirect Traumatic optic neuropathy (ITON) is a severe disease characterized by a sudden decline of visual function after craniofacial injury. However, the best treatment for ITON is unknown. Endoscopic transnasal optic canal decompression (ETOCD) has gradually been used for ITON treatment worldwide in recent years.

OBJECTIVE

To assess the effect of ETOCD on visual acuity in patients with ITON and identify factors that affect prognosis.

METHODS

In this study, clinical characteristics of 44 ITON patients who underwent ETOCD in Qilu Hospital of Shandong University were retrospectively analyzed. Factors affecting prognosis were also evaluated.

RESULTS

ETOCD treatment improved the vision of 20 (45.5%) patients with no patient suffering from vision deterioration. The mean value of visual acuity (VA) scores improved from 1.57 to 2.39 (P < 0.001). Patients with residual vision had a better VA improvement percent than those without light perception (66.67% versus 34.48%, χ² = 4.13, P = 0.042). Although shorter duration before ETOCD was associated with better improvement score in ITON patients (r = -0.30, P = 0.044), optic canal fracture (OCF) and optic nerve sheath incision did not affect the prognosis of these patients. Five ITON patients with cerebrospinal fluid rhinorrhea were treated with free nasal mucosal flap during the surgery, and no other severe surgical complication occurred.

CONCLUSIONS

ETOCD can effectively and safely improve the vision of ITON patients, patients with residual vision and those treated earlier may benefit more from this surgery.

Traumatic optic neuropathy: a review of current studies

Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma that directly or indirectly damages the optic nerve and can cause severe vision loss. The incidence of TON has been gradually increasing in recent years. Research on the protection and regeneration of the optic nerve after the onset of TON is still at the level of laboratory studies and which is insufficient to support clinical treatment of TON. And, due to without clear guidelines, there is much ambiguity regarding its diagnosis and management. Clinical interventions for TON include observation only, treatment with corticosteroids alone, or optic canal (OC) decompression (with or without steroids). There is controversy in clinical practice concerning which treatment is the best. A review of available studies shows that the visual acuity of patients with TON can be significantly improved after OC decompression surgery (especially endoscopic transnasal/transseptal optic canal decompression (ETOCD)) with or without the use of corticosteroids. And new findings of laboratory studies such as mitochondrial therapy, lipid change studies, and other studies in favor of TON therapy have also been identified. In this review, we discuss the evolving perspective of surgical treatment and experimental study.