外伤性视神经病变与视力预后相关的因素

 目的 分析影响外伤性视神经病变(traumatic optic neuropathy,TON)患者与视力预后相关的因素。方法 采用回顾性病例对照研究。对96例(97眼) TON患者的临床资料进行分析,通过单因素分析初步筛选出影响因素,再将这些因素纳入多因素分析( Logistic 回归分析),筛选出影响视力预后的因素。结果 经过激素或激素联合手术治疗,44眼(43.14%)视力得到改善。单因素分析结果显示:受伤时间距离治疗时间、伤后是否有光感、是否合并视神经管骨折、是否行视神经管减压术、是否存在蝶窦/筛窦积血、是否昏迷,两组间的视力预后有统计学差异。多因素分析显示:受伤时间≥2 d(OR=0.233),合并蝶窦/筛窦积血(OR=0.307)是视力改善的危险因素,伤后有光感(OR=14.866)是视力改善的保护因素。结论 TON视力预后与多种临床因素有关,是否手术对于预后无明显影响。明确影响视力预后的危险因素和保护因素,有利于临床医师制定合理的临床策略,指导治疗。

Analysis of relevant factors affecting prognosis in patients with traumatic optic neuropathy

Objective To investigate the clinical affecting factors on visual acuity recovery in patients with traumatic optic neuropathy (TON). Methods A retrospective study was conducted to analyze the clinical characteristics and prognosis of 96 patients (97 eyes) of TON. Potential prognostic factors on visual acuity were screened by χ² test preliminarily, then involved multiple logistic regression analyses. Results 44 eyes (43.14%) experienced visual improvement after treatment. Single factor analysis showed that there were statistical differences in having light perception after injury, optic nerve canal fracture, surgery of optic nerve canal decompression, hemorrhage within ethmoid and /or sphenoid sinus, coma or not, and time from injury to treatment (≥2 d, or <2 d) in prognosis of visual acuity. Nonconditional logistic regression analysis showed that combination with hemorrhage within ethmoid and /or sphenoid sinus(OR=0.307)and more than 48 hours from injury to treatment(OR=0.233) were risk factors of visual acuity recovery, and the existence of light perception(OR=14.866)was protective factor of visual acuity recovery. Conclusions The visual acuity recovery in patients of TON is related to many clinical factors. Surgery is not related to visual acuity recovery. Identification of protective and risk factors is beneficial to making clinical strategy and directing treatment for clinical physician.