Abstract

A PROSPECTIVE STUDY ON OUTCOME OF ENDOSCOPIC OPTIC NERVE DECOMPRESSION FOR VISUAL LOSS AFTER CRANIO - ORBITAL TRAUMA

Author(s): A. Shahul Hameed1, P. Muraleedharan Nampoothiri2, Bincy Joseph3

ABSTRACT: Optic nerve damage after cranio-orbital trauma is Traumatic Optic Neuropathy (TON). The optic nerve may be damaged directly or indirectly after cranio-orbital trauma as a result of transection of nerve fibers, interruption of blood supply, or secondary hemorrhage and edema. The injury to the optic nerve fibers by transection or infarction at the time of injury results in permanent damage whereas neural dysfunction secondary to compression within the optic canal, as a result of edema and hemorrhage, may respond to medical or surgical intervention as optic nerve decompression. Present study was conducted to assess the outcome of endoscopic optic nerve decompression for visual loss after cranio-orbital trauma. Ten cases of traumatic optic neuropathy were included in this prospective study. All these were road traffic accident cases and were referred from ophthalmology department. RAPD was in grade 2-3 in all patients. Trans nasal endoscopic optic nerve decompression was done 2-8 days after trauma. Out of ten, 7 patients with residual vision ranging from perception of light to 2m CF and 1 patient with no residual vision (total 8 out of 10, 80%), had improvement and recovered to normal vision after trans nasal endoscopic optic nerve decompression. Two patients with no residual vision showed no improvement even after optic decompression. The majority of the patients who recovered to normal vision (5 out of 8, 63%) were operated 2-4 days after trauma. Trans nasal endoscopic optic nerve decompression is an effective and safe treatment for traumatic optic neuropathy and the factors which predict good prognosis for visual recovery include a short time interval between trauma and intervention, and residual vision at presentation.