外伤性视神经病变手术与大剂量皮质激素治疗的评价

目的 评价视神经减压术与大剂量皮质激素对外伤性视神经病变的治疗作用和影响预后的相关因素。 方法 外伤性视神经病变40例40只眼，14例施行经颅、经鼻窦内窥镜和经眶筛途径视神经减压术；11例应用大剂量皮质激素(地塞米松1 mg/kg 5例，甲泼尼龙30 mg/kg 6例)治疗；15例在院外采用自选非特殊疗法治疗。根据最终视力和治疗后近期视力变化，评价手术、大剂量皮质激素和非特殊疗法治疗的疗效，并通过多因素分析筛选影响视力预后的相关因素。 结果 40例患者中最终视力无光感者19例，占47.5%；光感～0.02者12例，占30.0%；0.05以上者9例，占22.5%。大剂量皮质激素治疗组的优势比为2.96(P=0.0125)，最终视力明显好于手术治疗组(P=0.005)和非特殊治疗组(P=0.023)；治疗后近期有效率比手术治疗组高(P=0.024)。伤后无光感比有光感以上视力对最终有无视力恢 复的危险度增加2.14倍(P=0.0349)。 结论 大剂量皮质激素对外伤性视神经病变有治疗作用；手术减压效果不肯定；外伤后无光感是视力预后不良的危险因素。 (中华眼底病杂志,2000,16:75-77)

Assessment of surgical and high-dose corticosteroid treatment in traumatic optic neuropathy

Objective To evaluate the treatment of surgery and high-dose corticosteroid relevant factors to prognosis in traumatic optic neuropathy. Methods Forty patients(40 eyes) with traumatic optic neuropathy were enrolled.Optic nerve decompression using　transcranial approaches,sinus endoscopy and orbital-ethmoidal sinus rout were performed in 14 patients.Eleven patients were treated with high-dose corticosteroids (5 cases with 1 mg/kg dexamethasone,6 cases with 30 mg/kg methylprednisolone) and 15 patients received nonspecific management chose by themselves.The outcomes of visual acuity in short term and final stage were compared between surgery,high-dose corticosteroid and nonspecific treatment.Multiple variable analysis was done to determine the factors affecting the outcome of visual acuity. Results No light perception were found in 19 cases (19 out of 44 cases,47.5%),whereas visual acuity was light perception to 0.02 in 12 cases　(30.0%)　and 0.05 or better in 9 cases　(22.5%).The odds ratio of high-dose corticosteroid to nonspecific therapy was 2.96　(P=0.0125).The final visual acuity in patients treated with high-dose corticosteroid were better than other two groups (P=0.005,P=0.023,respectively).The short term　(within 3 days)　effective rate was higher in corticosteroid therapy group than operated group　(P=0.024).No light perception following optic nerve trauma appeared to be more danger as 2.14 folds　(P=0.0349)　than those with light perception or better in term of final visual acuity outcome. Conclusions High-dose corticosteroid may be benefit to traumatic optic neuropathy.The treatment in traumatic optic neuropathy using optic nerve decompression needs to be determined.No light perception at initial is an important risk factor in the outcome.(Chin J Ocul Fundus Dis,2000,16:75-77)