1
|
Hassan B, Yoon J, Elegbede A, Merbs SL, Liang F, Miller NR, Manson PN, Grant MP. The Association Between Craniofacial Fracture Patterns and Traumatic Optic Neuropathy. J Craniofac Surg 2024:00001665-990000000-01418. [PMID: 38534175 DOI: 10.1097/scs.0000000000010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 03/28/2024] Open
Abstract
Traumatic optic neuropathy (TON) is a rare but potentially devastating complication of craniofacial trauma. Approximately half of patients with TON sustain permanent vision loss. In this study, we sought to identify the most common fracture patterns associated with TON. We performed a retrospective review of craniomaxillofacial CT scans of trauma patients who presented to the R Adams Cowley Shock Trauma Center from 2015 to 2017. Included were adult patients who had orbital fractures with or without other facial fractures. Patients diagnosed with TON by a formal ophthalmologic examination were analyzed. Craniofacial fracture patterns were identified. Bivariate analysis and multivariate logistic regression were performed to identify craniofacial fracture patterns most commonly associated with TON. A total of 574 patients with orbital fractures who met inclusion criteria [15 (2.6%)] were diagnosed with TON. The median [interquartile range (IQR)] age was 44 (28-59) years. Patients with optic canal fractures and sphenoid sinus fractures had greater odds of TON compared with patients who did not have these fracture types [adjusted odds ratio (aOR) 95% confidence interval (CI) 31.8 (2.6->100), 8.1 (2.7-24.4), respectively]. Patients who sustain optic canal and sphenoid sinus fractures in the setting of blunt facial trauma are at increased odds of having a TON. Surgeons and other physicians involved in the care of these patients should be aware of this association.
Collapse
Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Joshua Yoon
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
- Department of Surgery, George Washington University Hospital, Washington, DC
| | - Adekunle Elegbede
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Shannath L Merbs
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Neil R Miller
- Departments of Ophthalmology, Neurology, and Neurosurgery, Johns Hopkins Hospital, Baltimore, MD
| | - Paul N Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
| |
Collapse
|
2
|
Srisombut T, Ittipanichpong P, Arjkongharn N, Tangon D, Kreesang R, Kemchoknatee P. Factors predictive of poor visual outcome in indirect traumatic optic neuropathy: A retrospective cohort study. Injury 2024; 55:111238. [PMID: 38091645 DOI: 10.1016/j.injury.2023.111238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION The gold standard treatment for indirect traumatic optic neuropathy (ITON) has not yet been conclusively established, and it is essential to gain an understanding of visual prognosis and to counsel patients regarding the predictive risk factors of poor visual outcomes. Currently, there is limited information regarding ITON in Thai populations; therefore, this study aimed to determine the risk factors of poor visual outcome in patients with this condition. METHODS A retrospective review was conducted of all ITON cases diagnosed at Rajavithi Hospital and Sawanpracharak Hospital between January 2016 and December 2022 in order to determine clinical characteristics and evaluate associated risk factors of poor visual prognosis using binary logistic regression analysis. RESULTS The mean age of this cohort of 101 patients was 36.17 years, with a male predominance of 73.3 %. Motor vehicle accidents were the most common cause of ITON, with a statistically significant 79.2 % of cases. The patients were categorized into an "improved group" of 29 patients and an "unimproved group" of 72. The unimproved group had a significantly older mean age and poorer initial visual acuity of 20/200 (p-values 0.001 and p < 0.001 respectively). There was no significant difference between Computed Tomography (CT) findings in the two groups. The improved group had significantly better visual acuity (VA) at 1-month and final follow-up visit than the unimproved group (both p < 0.001). Differences between gender, Glasgow coma score, associated underlying diseases, and duration from trauma to intravenous glucocorticoids therapy in the two groups were not statistically significant. Multivariable logistic regression analysis identified patient age of 40 years or more (Odds ratio (OR) 3.447, 95 % CI, 1.085-10.955, p = 0.036) and poor baseline VA (OR 6.628, 95 % Confidence Interval (CI), 2.308-19.036, p < 0.001) as significant risk factors for poor visual outcome in ITON patients. CONCLUSIONS No clear benefit was found of intravenous glucocorticoids in treatment of ITON. Patients aged 40 years or more and/or with poor baseline visual status should be advised that they are at increased risk of poor final visual outcomes.
Collapse
Affiliation(s)
- Thansit Srisombut
- Department of Surgery, Sawanpracharak Hospital, 3 Attakavee, Pak Nam Pho, Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand
| | - Paradee Ittipanichpong
- Department of Ophthalmology, Sawanpracharak Hospital, 3 Attakavee, Pak Nam Pho, Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand
| | - Niracha Arjkongharn
- Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2, Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, 10400, Thailand
| | - Duanghathai Tangon
- Faculty of Medicine, Rangsit University, Rajavithi Hospital, 2, Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Rinrada Kreesang
- Department of Surgery, Sawanpracharak Hospital, 3 Attakavee, Pak Nam Pho, Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand
| | - Parinee Kemchoknatee
- Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2, Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, 10400, Thailand.
| |
Collapse
|
3
|
Siyanaki MRH, Azab MA, Lucke-Wold B. Traumatic Optic Neuropathy: Update on Management. ENCYCLOPEDIA 2023; 3:88-101. [PMID: 36718432 PMCID: PMC9884099 DOI: 10.3390/encyclopedia3010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Traumatic optic neuropathy is one of the causes of visual loss caused by blunt or penetrating head trauma and is classified as both direct and indirect. Clinical history and examination findings usually allow for the diagnosis of traumatic optic neuropathy. There is still controversy surrounding the management of traumatic optic neuropathy; some physicians advocate observation alone, while others recommend steroid therapy, surgery, or both. In this entry, we tried to highlight traumatic optic neuropathy's main pathophysiologic mechanisms with the most available updated treatment. Recent research suggests future therapies that may be helpful in traumatic optic neuropathy cases.
Collapse
Affiliation(s)
| | - Mohammed A. Azab
- Department of Neurosurgery, University of Cairo University, Cairo 12613, Egypt
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| |
Collapse
|
4
|
Wright AJ, Queen JH, Supsupin EP, Chuang AZ, Chen JJ, Foroozan R, Adesina OOO. Prognosticators of Visual Acuity After Indirect Traumatic Optic Neuropathy. J Neuroophthalmol 2022; 42:203-207. [PMID: 35427298 PMCID: PMC9124665 DOI: 10.1097/wno.0000000000001521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study is to determine whether there are radiographic and systemic clinical characteristics that can predict final visual outcomes in patients with indirect traumatic optic neuropathy (iTON). METHODS This study is a retrospective, multicenter case series of adult patients with iTON treated initially at large, urban, and/or academic trauma centers with follow-up at an affiliated ophthalmology clinic. In addition to detailed cranial computed tomography characteristics, demographics, systemic comorbidities, coinjuries, blood products administered, and intracranial pressure, along with other factors, were gathered. LogMAR visual acuity (VA) at the initial presentation to the hospital and up to 12 months follow-up was collected. RESULTS Twenty patients met inclusion criteria; 16 (80%) were men with a mean age of 40.9 years (±20.9). Mean initial VA was 1.61 logMAR (∼20/800, ± 0.95), and final VA was 1.31 logMAR (∼20/400, ± 1.06). Three patients (4 eyes) had no light perception (NLP) VA at presentation and remained NLP at final follow-up. Of the predictors analyzed, only the initial VA was found to be a significant predictor of visual outcome. The presence of orbital fractures, intraconal and/or extraconal hemorrhage, as well as systemic comorbidities, were not found to significantly affect visual outcome. CONCLUSIONS After evaluating multiple factors, initial VA was the only factor associated with visual prognosis in iTON. This knowledge may better enable clinicians to predict visual prognosis and set reasonable expectations with patients and families at the time of injury.
Collapse
Affiliation(s)
- Alex J. Wright
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Robert Cizik Eye Clinic, Houston, TX, USA
- Lyndon B. Johnson Hospital, Harris Health, Houston, TX, USA
| | - Joanna H. Queen
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Robert Cizik Eye Clinic, Houston, TX, USA
- Lyndon B. Johnson Hospital, Harris Health, Houston, TX, USA
| | - Emilio P. Supsupin
- Department of Diagnostic & Interventional Imaging McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Alice Z. Chuang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - John J. Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rod Foroozan
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston TX, USA
| | - Ore-ofe O. Adesina
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Robert Cizik Eye Clinic, Houston, TX, USA
- Lyndon B. Johnson Hospital, Harris Health, Houston, TX, USA
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
5
|
Lourthai P, Choopong P, Dhirachaikulpanich D, Soraprajum K, Pinitpuwadol W, Punyayingyong N, Ngathaweesuk Y, Tesavibul N, Boonsopon S. Visual outcome of endogenous endophthalmitis in Thailand. Sci Rep 2021; 11:14313. [PMID: 34253792 PMCID: PMC8275623 DOI: 10.1038/s41598-021-93730-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/23/2021] [Indexed: 01/16/2023] Open
Abstract
To evaluate a 10-year visual outcome of endogenous endophthalmitis (EE) patients. A 10-year retrospective chart review of EE patients. Thirty-eight patients (40 eyes) were diagnosed with EE at the mean age of 42. Among the identifiable pathogens (71.1% culture positive), the causative agents were predominantly gram-negative bacteria (48.1%). The most common specie was Klebsiella pneumoniae (25.9%). About a quarter of the patients required surgical eye removal, and the remaining 45.7% had visual acuity (VA) worse than hand motion at one month after the infectious episode. The most common complication was ocular hypertension (52.5%). Poor initial VA was significantly associated with a worse visual outcome in the early post-treatment period (p 0.12, adjusted OR 10.20, 95% CI 1.65–62.96). Five patients continued to visit the clinic for at least ten years. One patient had gained his vision from hand motion to 6/7.5. Two patients had visual deterioration, one from corneal decompensation, and the other from chronic retinal re-detachment. Two patients developed phthisis bulbi, with either some VA perception of light or no light perception. Poor initial VA is the only prognostic factor of a poor early post-treatment visual outcome of EE.
Collapse
Affiliation(s)
- Preeyachan Lourthai
- Ophthalmology Department, Mettapracharak Hospital, Rai Khing, Sampran, Nakornpathom, 73210, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Dhanach Dhirachaikulpanich
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Kunravitch Soraprajum
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Warinyupa Pinitpuwadol
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Noppakhun Punyayingyong
- Ophthalmology Department, Mettapracharak Hospital, Rai Khing, Sampran, Nakornpathom, 73210, Thailand
| | - Yaninsiri Ngathaweesuk
- Department of Ophthalmology, Faculty of Medicine, Phramongkutklao Hospital, Phramongkutklao College of Medicine, 315 Ratchawithi Road, Thung Payathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| |
Collapse
|
6
|
Abstract
BACKGROUND Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis. METHODS The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses. RESULTS In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases. CONCLUSIONS Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
|
7
|
Karimi S, Arabi A, Ansari I, Shahraki T, Safi S. A Systematic Literature Review on Traumatic Optic Neuropathy. J Ophthalmol 2021; 2021:5553885. [PMID: 33728056 PMCID: PMC7935564 DOI: 10.1155/2021/5553885] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 01/01/2023] Open
Abstract
Traumatic optic neuropathy (TON) is an uncommon vision-threatening disorder that can be caused by ocular or head trauma and is categorized into direct and indirect TON. The overall incidence of TON is 0.7-2.5%, and indirect TON has a higher prevalence than direct TON. Detection of an afferent pupillary defect in the presence of an intact globe in a patient with ocular or head trauma with decreased visual acuity strongly suggests TON. However, afferent pupillary defects may be difficult to detect in patients who have received narcotics that cause pupillary constriction and in those with bilateral TON. Mechanical shearing of the optic nerve axons and contusion necrosis due to immediate ischemia from damage to the optic nerve microcirculation and apoptosis of neurons is a probable mechanism. The proper management of TON is controversial. High-dose corticosteroid therapy and decompression of the optic nerve provide no additional benefit over observation alone. Intravenous erythropoietin may be a safe and efficient treatment for patients with TON.
Collapse
Affiliation(s)
- Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Iman Ansari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Li Y, Singman E, McCulley T, Wu C, Daphalapurkar N. The Biomechanics of Indirect Traumatic Optic Neuropathy Using a Computational Head Model With a Biofidelic Orbit. Front Neurol 2020; 11:346. [PMID: 32411088 PMCID: PMC7198902 DOI: 10.3389/fneur.2020.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Indirect traumatic optic neuropathy (ITON) is an injury to the optic nerve due to head trauma and usually results in partial or complete loss of vision. In order to advance a mechanistic understanding of the injury to the optic nerve, we developed a head model with a biofidelic orbit. Head impacts were simulated under controlled conditions of impactor velocity. The locations of impact were varied to include frontal, lateral, and posterior parts of the head. Impact studies were conducted using two types of impactors that differed in their rigidity relative to the skull. The simulated results from both the impactors suggest that forehead impacts are those to which the optic nerve is most vulnerable. The mode and location of optic nerve injury is significantly different between the impacting conditions. Simulated results using a relatively rigid impactor (metal cylinder) suggest optic nerve injury initiates at the location of the intracranial end of the optic canal and spreads to the regions of the optic nerve in the vicinity of the optic canal. In this case, the deformation of the skull at the optic canal, resulting in deformation of the optic nerve, was the primary mode of injury. On the other hand, simulated results using a relatively compliant impactor (soccer ball) suggest that primary mode of injury comes from the brain tugging upon the optic nerve (from where it is affixed to the intracranial end of the optic canal) during coup countercoup motion of the brain. This study represents the first published effort to employ a biofidelic simulation of the full length of the optic nerve in which the orbit is integrated within the whole head.
Collapse
Affiliation(s)
- Yang Li
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China.,Hopkins Extreme Materials Institute, Johns Hopkins University, Baltimore, MD, United States
| | - Eric Singman
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Timothy McCulley
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Chengwei Wu
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Nitin Daphalapurkar
- Hopkins Extreme Materials Institute, Johns Hopkins University, Baltimore, MD, United States.,Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
9
|
Ma YJ, Yu B, Tu YH, Mao BX, Yu XY, Wu WC. Prognostic factors of trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy. Int J Ophthalmol 2018; 11:1222-1226. [PMID: 30046543 DOI: 10.18240/ijo.2018.07.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 03/27/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate a possible correlation between visual acuity (VA) prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy (ITON). METHODS From July 1st, 2012 to July 1st, 2015, 224 adults diagnosed with ITON who underwent endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) were reviewed. Visual outcome before and after treatment were taken into comparison. RESULTS Accompanied older in age, longer time to medical treatment and existence of optic canal fracture (OCF) were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity (IDVA), while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF (t=2.272, P<0.05). CONCLUSION Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.
Collapse
Affiliation(s)
- Ying-Jie Ma
- Eye Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Bo Yu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yun-Hai Tu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Bang-Xun Mao
- Eye Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xin-Yi Yu
- Eye Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Wen-Can Wu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| |
Collapse
|
10
|
Yu B, Chen Y, Ma Y, Tu Y, Wu W. Outcome of endoscopic trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy in children. BMC Ophthalmol 2018; 18:152. [PMID: 29940917 PMCID: PMC6020208 DOI: 10.1186/s12886-018-0792-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/22/2018] [Indexed: 02/08/2023] Open
Abstract
Background To evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON). Methods From July 1st, 2008 to July 1st, 2015, 62 children diagnosed with ITON who underwent ETOCD were reviewed. Main outcome measure was improvement in visual acuity after treatment. Results Altogether 62 children (62 eyes) with a mean age of 11.26 ± 4.14 years were included. Thirty-three (53.2%) of them had residual vision before surgery while 29 (46.8%) had no light perception (NLP). The overall visual acuity improvement rate after surgery was 54.84%. The improvement rate of patients with residual vision (69.70%) was significant higher than that of patients with no light perception (NLP) (37.9%) (P = 0.012). However, no significant difference was shown among patients with different residual vision (P = 0.630). Presence of orbital and/ or optic canal fracture and hemorrhage within the post-ethmoid and/or sphenoid sinus resulted in poor postoperative visual acuity, duration of presenting complaints did not affect final visual acuity or did not effect outcomes. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome. Three patients developed cerebrospinal fluid rhinorrhea and one encountered cavernous sinus hemorrhage during surgery. No other severe complications were observed. Conclusion Children with residual vision had better postoperative visual prognosis and benefited more from ETOCD than children with NLP. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome, however, this needs to be reassessed in children presenting long after the injury.Treatment should still be recommended even for cases of delayed presentation to hospital.
Collapse
Affiliation(s)
- Bo Yu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, No.270 West Xueyuan Road, Wenzhou, Zhejiang, People's Republic of China
| | - Yingbai Chen
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Yingjie Ma
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunhai Tu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, No.270 West Xueyuan Road, Wenzhou, Zhejiang, People's Republic of China
| | - Wencan Wu
- Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, No.270 West Xueyuan Road, Wenzhou, Zhejiang, People's Republic of China.
| |
Collapse
|
11
|
Kelishadi SS, Zeiderman MR, Chopra K, Kelamis JA, Mundinger GS, Rodriguez ED. Facial Fracture Patterns Associated with Traumatic Optic Neuropathy. Craniomaxillofac Trauma Reconstr 2018; 12:39-44. [PMID: 30815214 DOI: 10.1055/s-0038-1641172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/24/2017] [Indexed: 10/17/2022] Open
Abstract
Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common "groups" or fracture patterns among the study population. Group 1 ( n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 ( n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 ( n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 ( n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 ( n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.
Collapse
Affiliation(s)
| | - Matthew R Zeiderman
- Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, California
| | - Karan Chopra
- Section of Plastic Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Joseph A Kelamis
- Section of Plastic Surgery, Mercy Clinic in Fort Smith, Fort Smith, Arkansas
| | - Gerhard S Mundinger
- Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Eduardo D Rodriguez
- Department of Plastic Surgery, New York University Langone Medical Center, New York
| |
Collapse
|
12
|
Sefi-Yurdakul N, Koç F. Risk factors affecting the visual outcome in patients with indirect traumatic optic neuropathy. Int Ophthalmol 2017; 38:1647-1652. [PMID: 28681279 DOI: 10.1007/s10792-017-0637-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the etiology and possible prognostic factors affecting the visual outcome in patients with indirect traumatic optic neuropathy (TON). METHODS The records of patients with indirect TON were reviewed and compared the results of treatment with high doses of corticosteroids (Group 1) and simple observation without treatment (Group 2). RESULTS The mean age at the time of injury was 34.7 ± 11.4 (18-58) years in Group 1 and 37.5 ± 17.7 (8-73) years in Group 2 (p = 0.513). The mean value for the first referral of the patient to the ophthalmology clinic following trauma was 2.4 ± 2.4 (1-10) days in Group 1 and 16.7 ± 13.9 (1-30) days in Group 2 (p = 0.004). The most common causes of trauma were road traffic collision (57.1 and 68%) in the Group 1 and 2, respectively (p = 0.606). The mean initial visual acuity was 0.03 ± 0.07 (0.00-0.30) in Group 1 and 0.17 ± 0.21 (0.00-0.80) decimal in Group 2 patients (p = 0.001). The mean visual acuity at the final follow-up was 0.21 ± 0.35 (0.00-1.00) and 0.46 ± 0.42 (0.00-1.00) in Group 1 and Group 2, respectively, indicating better initial and final visual acuity values in Group 2 (p = 0.022), and also a statistically significant recovery of visual acuity between initial and final values in both groups (p < 0.05). The most important determinant of the final visual acuity was initial visual acuity (p < 0.001; 95.0% CI: 0.792-2.096). CONCLUSIONS Our study demonstrated that road traffic collision is the leading cause of indirect traumatic optic neuropathy, and the best predictor of final visual acuity outcome is the initial visual acuity.
Collapse
Affiliation(s)
- Nazife Sefi-Yurdakul
- Department of Ophthalmology, İzmir Atatürk Education and Research Hospital, Halk Sokak, No: 26 Sahilevleri, 35320, Narlıdere, İzmir, Turkey.
| | - Feray Koç
- Department of Ophthalmology, İzmir Atatürk Education and Research Hospital, Halk Sokak, No: 26 Sahilevleri, 35320, Narlıdere, İzmir, Turkey
| |
Collapse
|
13
|
Abstract
BACKGROUND Traumatic optic neuropathy is characterized by sudden loss of vision following facial trauma leading to variable visual deficits. The purpose of this study was to evaluate recent institutional trends in the treatment of traumatic optic neuropathy, evaluate the outcomes of different treatment strategies, and identify factors associated with improved vision. METHODS Institutional review board approval was obtained to retrospectively review patients diagnosed with traumatic optic neuropathy at a high-volume trauma center from 2004 to 2012. Pretreatment and posttreatment visual acuity was compared using quantitative analysis of standard ophthalmologic conversion. RESULTS A total of 109 patients met inclusion criteria (74.3 percent male patients), with a mean age of 38.0 ± 17.5 years (range, 8 to 82 years). Management of traumatic optic neuropathy involved intravenous corticosteroids alone in 8.3 percent of patients (n = 9), 56.9 percent (n = 62) underwent observation, 28.4 percent (n = 31) had surgical intervention, and 6.4 percent (n = 7) underwent surgery and corticosteroid administration. Only 19.3 percent of patients returned for follow-up. Vision improved in 47.6 percent of patients, with a mean follow-up of 12.9 weeks. Patients younger than 50 years had a trend toward higher rates of visual improvement, 60 percent versus 16.7 percent (p = 0.15). CONCLUSIONS The majority of traumatic optic neuropathy patients are unlikely to return for a follow-up examination. Optic nerve decompression has fallen out of favor in the authors' institution, and observation is the most common management strategy. Outcomes following corticosteroid administration and observation are comparable. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
14
|
Singman EL, Daphalapurkar N, White H, Nguyen TD, Panghat L, Chang J, McCulley T. Indirect traumatic optic neuropathy. Mil Med Res 2016; 3:2. [PMID: 26759722 PMCID: PMC4709956 DOI: 10.1186/s40779-016-0069-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/04/2016] [Indexed: 01/12/2023] Open
Abstract
Indirect traumatic optic neuropathy (ITON) refers to optic nerve injury resulting from impact remote to the optic nerve. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, mitigation or treatment. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports- or motor vehicle-related concussion, rather than military-related ballistic or blast damage. Research in this field will likely require the development of robust databases to identify patients with ITON and follow related outcomes, in addition to both in-vivo animal and virtual human models to study the mechanisms of damage and potential therapies.
Collapse
Affiliation(s)
- Eric L Singman
- Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland USA
| | | | - Helen White
- Director of Informatics and Information Management, Vision Center of Excellence [VCE], Office of the Assistant Secretary of Defense for Health Affairs [ASD-HA], United States Department of Defense [DOD], Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Thao D Nguyen
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Lijo Panghat
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Jessica Chang
- Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland USA
| | - Timothy McCulley
- Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland USA
| |
Collapse
|
15
|
Andrews BT, Jackson AS, Nazir N, Hromas A, Sokol JA, Thurston TE. Orbit fractures: Identifying patient factors indicating high risk for ocular and periocular injury. Laryngoscope 2015; 126 Suppl 4:S5-11. [PMID: 26690301 DOI: 10.1002/lary.25805] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Maxillofacial trauma frequently involves the bony orbit that surrounds the ocular globe. Concomitant globe injury is a concern whenever orbit trauma occurs and in severe cases can occasionally result in vision loss. The mechanism of injury, physical exam findings, and radiographic imaging can provide useful information concerning the severity of the injury and concerns for vision loss. Using these three tools, it is hypothesized that the patient's history, physical exam, and radiographic findings can identify high-risk maxillofacial trauma patients with concomitant ocular injury. Identification of high risk patients who require comprehensive ophthalmologic evaluation may alter management and possibly preserve or restore vision. STUDY DESIGN A retrospective clinical chart review was performed at a tertiary academic medical center. METHODS Subjects were identified using the institutional trauma registry. Data collected included subject demographics, patient medical records and notes, ophthalmologic testing, and radiographic imaging. The incidence of orbit fracture and concomitant ocular injury associated with the mechanism of injury, physical exam findings, and radiographic imaging was determined. Statistical analysis was performed using a chi-square and Fisher exact test. RESULTS In this study, 279 subjects with orbit fractures were identified and the incidence of concomitant ocular injury was 27.6% (77 of 279). Mechanism of injury was statistically associated with an increased risk of ocular injury (P = 0.0340), with penetrating trauma being the most likely etiology. The physical exam findings of visual acuity and an afferent pupillary defect were statistically associated with ocular injury (P = 0.0029 and 0.0001, respectively). Depth of orbit fracture on radiographic imaging was statistically associated with ocular injury (P = 0.0024), with fractures extending to the posterior third of the orbit being most likely to have associated ocular injury. CONCLUSION Maxillofacial trauma patients with orbit fractures and concomitant ocular injury occur in more than one in four patients. Comprehensive ophthalmologic evaluation is recommended for all patients who sustain an orbit fracture. Subjects with a penetrating trauma mechanism of injury, physical exam findings of visual acuity deficits and an afferent pupillary defect, and radiographic imaging demonstrating fracture depth involvement of the posterior orbit are at highest risk for vision loss and warrant specific concern for ocular injury assessment. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Brian T Andrews
- Department of Otolaryngology and Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Anee Sophia Jackson
- Department of Otolaryngology and Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Niaman Nazir
- Department of Preventative Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Alan Hromas
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Jason A Sokol
- Department of Ophthalmology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Todd E Thurston
- Department of Otolaryngology and Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| |
Collapse
|
16
|
|
17
|
Traumatic optic neuropathy: facial CT findings affecting visual acuity. Emerg Radiol 2015; 22:351-6. [PMID: 25563705 DOI: 10.1007/s10140-014-1292-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to determine the relationship between admission visual acuity (VA) and facial computed tomographic (CT) findings of traumatic optic neuropathy (TON). We retrospectively evaluated CT findings in 44 patients with TON. Mid-facial fractures, extraconal and intraconal hematomas, hematomas along the optic nerve and the posterior globe, optic canal fracture, nerve impingement by optic canal fracture fragment, and extraconal and intraconal emphysema were evaluated. CT variables of patients with and without available VA were compared. VA was converted into logarithm of the minimum angle of resolution (logMAR) to provide a numeric scale for the purpose of statistical analysis. The risk factors related to poor VA on univariate analysis were as follows: intraconal hematoma [median logMAR -4.7 versus -1.15, p = 0.016] and hematoma along the optic nerve [median -4.7 versus -1.3, p = 0.029]. Intraconal hematoma was the best predictor of poor VA (coefficient, 1.01; SE, 0.34; and p = 0.008). Receiver operating characteristic (ROC) curve analysis showed that the presence of intraconal hematoma and hematoma along the optic nerve predicted poor VA (logMAR of -3.7 or lower) with an area under the curve of 0.8 and 0.85, respectively. TON patients at higher risk of severe visual impairment may be identified based on admission facial CT.
Collapse
|
18
|
Bodanapally UK, Van der Byl G, Shanmuganathan K, Katzman L, Geraymovych E, Saksobhavivat N, Mirvis SE, Sudini KR, Krejza J, Shin RK. Traumatic Optic Neuropathy Prediction after Blunt Facial Trauma: Derivation of a Risk Score Based on Facial CT Findings at Admission. Radiology 2014; 272:824-31. [DOI: 10.1148/radiol.14131873] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Patel R, Reid RR, Poon CS. Multidetector computed tomography of maxillofacial fractures: the key to high-impact radiological reporting. Semin Ultrasound CT MR 2013; 33:410-7. [PMID: 22964407 DOI: 10.1053/j.sult.2012.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Maxillofacial fractures are very common. Recognizing patterns of facial fractures is helpful in assessing maxillofacial injury and accurately characterizing all fractures that may be present. Facial fractures are grouped into the following categories: nasal bone, naso-orbito-ethmoid, orbital, zygomatic, maxillary (including Le Fort-type fractures), mandibular, and frontal sinus fractures. Within each subgroup of facial fractures, there are key findings, whether of the fracture itself or of potential associated injuries, that are important factors in determining whether the patient is managed conservatively or with surgery. This article highlights the features of facial fractures that are the most important to the surgeons and provides a framework for effective radiological reporting.
Collapse
Affiliation(s)
- Rina Patel
- Department of Radiology, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | | | | |
Collapse
|
20
|
Thanos S, Böhm MRR, Schallenberg M, Oellers P. Traumatology of the optic nerve and contribution of crystallins to axonal regeneration. Cell Tissue Res 2012; 349:49-69. [PMID: 22638995 DOI: 10.1007/s00441-012-1442-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 04/26/2012] [Indexed: 11/29/2022]
Abstract
Within a few decades, the repair of long neuronal pathways such as spinal cord tracts, the optic nerve or intracerebral tracts has gone from being strongly contested to being recognized as a potential clinical challenge. Cut axonal stumps within the optic nerve were originally thought to retract and become irreversibly necrotic within the injury zone. Optic nerve astrocytes were assumed to form a gliotic scar and remodelling of the extracellular matrix to result in a forbidden environment for re-growth of axons. Retrograde signals to the ganglion cell bodies were considered to prevent anabolism, thus also initiating apoptotic death and gliotic repair within the retina. However, increasing evidence suggests the reversibility of these regressive processes, as shown by the analysis of molecular events at the site of injury and within ganglion cells. We review optic nerve repair from the perspective of the proximal axon stump being a major player in determining the successful formation of a growth cone. The axonal stump and consequently the prospective growth cone, communicates with astrocytes, microglial cells and the extracellular matrix via a panoply of molecular tools. We initially highlight these aspects on the basis of recent data from numerous laboratories. Then, we examine the mechanisms by which an injury-induced growth cone can sense its surroundings within the area distal to the injury. Based on requirements for successful axonal elongation within the optic nerve, we explore the models employed to instigate successful growth cone formation by ganglion cell stimulation and optic nerve remodelling, which in turn accelerate growth. Ultimately, with regard to the proteomics of regenerating retinal tissue, we discuss the discovery of isoforms of crystallins, with crystallin beta-b2 (crybb2) being clearly upregulated in the regenerating retina. Crystallins are produced and used to promote the elongation of growth cones. In vivo and in vitro, crystallins beta and gamma additionally promote the growth of axons by enhancing the production of ciliary neurotrophic factor (CNTF), indicating that they also act on astrocytes to promote axonal regrowth synergistically. These are the first data showing that axonal regeneration is related to crybb2 movement within neurons and to additional stimulation of CNTF. We demonstrate that neuronal crystallins constitute a novel class of neurite-promoting factors that probably operate through an autocrine and paracrine mechanism and that they can be used in neurodegenerative diseases. Thus, the post-injury fate of neurons cannot be seen merely as inevitable but, instead, must be regarded as a challenge to shape conditions for initiating growth cone formation to repair the damaged optic nerve.
Collapse
Affiliation(s)
- Solon Thanos
- Institute of Experimental Ophthalmology, School of Medicine, University of Münster, Albert-Schweitzer-Campus 1, D15, 48149 Münster, Germany.
| | | | | | | |
Collapse
|
21
|
Tabatabaei SA, Soleimani M, Alizadeh M, Movasat M, Mansoori MR, Alami Z, Foroutan A, Joshaghani M, Safari S, Goldiz A. Predictive value of visual evoked potentials, relative afferent pupillary defect, and orbital fractures in patients with traumatic optic neuropathy. Clin Ophthalmol 2011; 5:1021-6. [PMID: 21845028 PMCID: PMC3151564 DOI: 10.2147/opth.s21409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the predictive value of flash visual-evoked potentials (VEP), relative afferent pupillary defect, and presence of orbital fractures in patients with traumatic optic neuropathy. METHODS A prospective study was conducted in 15 patients with indirect traumatic optic neuropathy. All patients underwent a thorough ophthalmic examination. Initial visual acuity, final visual acuity, and relative afferent pupillary defect were determined, and visual acuity was converted into logMAR units. We performed flash VEP and an orbital computed tomography scan in all patients. RESULTS There was a good correlation between relative afferent pupillary defect and final visual acuity (r = -0.83), and better initial visual acuity could predict better final visual acuity (r = 0.92). According to findings from flash VEP parameters, there was a relationship between final visual acuity and amplitude ratio of the wave (r = 0.59) and latency ratio of the wave (r = -0.61). Neither primary visual acuity nor final visual acuity was related to the presence of orbital fractures in the orbital CT scan. CONCLUSION Patients with traumatic optic neuropathy often present with severe vision loss. Flash VEP, poor initial visual acuity, and higher grade of relative afferent pupillary defect could predict final visual acuity in these patients. Presence of orbital fracture was not a predictive factor for primary visual acuity or final visual acuity.
Collapse
Affiliation(s)
- Seyed Ali Tabatabaei
- Farabi Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Alsuhaibani AH. Orbital Fracture: Significance of lateral wall. Saudi J Ophthalmol 2010; 24:49-55. [PMID: 23960875 DOI: 10.1016/j.sjopt.2009.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 10/17/2009] [Indexed: 11/25/2022] Open
Abstract
The lateral orbital wall is the strongest among other orbital walls. However, it is commonly fractured in the setting of severe facial trauma. The fracture usually occurs at the sphenozygomatic suture line. In general, patients with lateral wall fractures are commonly young male who may present with mid facial swelling and some degree of deformity. In some cases, lateral orbital wall fracture may be associated with visual loss or change in mental status due to associated intracranial injury. Imaging studies with computed tomography is important in the proper diagnosis and planning of the surgical intervention. Management of intracranial or eye injuries should be undertaken on emergent basis. Thereafter, significantly displaced lateral wall fractures need to be repaired on timely basis. Proper realignment of the plane of the lateral orbital wall at the sphenozygomatic suture along with the other complex articulations of the zygomatic bone is necessary for proper functional and aesthetic outcome.
Collapse
Affiliation(s)
- Adel H Alsuhaibani
- Department of Ophthalmology, King Abdulaziz University Hospital, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
| |
Collapse
|
23
|
Perry M, Moutray T. Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 4: ‘Can the patient see?’ Timely diagnosis, dilemmas and pitfalls in the multiply injured, poorly responsive/unresponsive patient. Int J Oral Maxillofac Surg 2008; 37:505-14. [DOI: 10.1016/j.ijom.2007.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 07/29/2007] [Accepted: 11/06/2007] [Indexed: 11/15/2022]
|