颅外伤合并间接性视神经损伤

目的 探讨颅外伤合并间接性视神经损伤的临床诊断和治疗。方法 回顾分析了颅外伤合并间接性视神经损伤36例（36眼）的临床资料。11例行视神经减压术，25例接受药物治疗。结果 全部患者伤侧眼的相对瞳孔传入障碍（RAPD）阳性；眼眶CT扫描显示有眶壁和／或鼻窦骨折。药物治疗组有8例（32．00％）视力提高1行，其余17例（68．00％）视力无改善，手术治疗组有1例（909％）由数指／1．5m提高到03，5例（45．46％）恢复了瞳孔直接对光反应，1例（9．09％）恢复了VEP波，其余4例（36．36％）视力无改善。结论 对颅外伤患者应进行RAPD检查及眼眶CT扫描，确定有无间接性视神经损伤。皮质类固醇和视神经减压联合应用可能更有利于视功能的恢复。

Skull trauma associated with indirect optic nerve injury

Objective To investigate the clinical diagnosis and treatment in patients wih skull trauma and associated with indirect optic nerve injury. Methods The clinical data of 36 cases(36 eyes) with skull trauma and associated with indirect optic nerve injuery was reviewed,of which 11 cases were treated with surgery of optic nerve decompession and 25 cases with medicine. Results Relating afferent pupil defect(PAPD) was observed in traumatic eye in all patients,and fractures in orbital and/or nasanl sinus was revealed on CT scan.The visual acuity was increased one line in 8 eyes(32.00%),and not improve in the other 17 eyes(68.00%) in medical treatment group.In the visual acuity increased from C.F./1.5m to 0.3 in one eye(9.09%),directive pupil reaction recovered in 5 eyes(45.46%),VEP recovered in l eye((9.09%)),and no recovery in the other 4 eyes(36.36%).Conclusion The inspection of RAPD and CT scan is important for patients with skull trauma to determine the present of indirect optic nerve injury.It might be more effective that combination of corticosteroids and optic nerve decompression in patients with indirect optic nerve injury.