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.