The treatment of traumatic optic neuropathy - The International Optic Nerve Trauma Study
The treatment of traumatic optic neuropathy - The International Optic Nerve Trauma Study
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DOI：
10.1016/s0161-6420(99)00707-1
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发表时间：
1999-07-01
期刊：
影响因子：
13.7
通讯作者：
Kraker, R
中科院分区：
文献类型：
--
作者：
Levin, LA;Beck, RW;Kraker, R
目的比较外伤性视神经病变采用皮质类固醇治疗、视神经管减压手术治疗和不治疗治疗的视觉效果。设计与同期治疗组的非随机介入研究。参与者共133例外伤性视神经病变患者（127例单侧，6例双侧），他们在受伤后3天内进行了初步视力评估。纳入初步分析需要至少1个月的随访。干预根据损伤后7天内的治疗情况，将单侧损伤患者分为三个治疗组：未治疗组（n = 9）、皮质类固醇治疗组（n = 85）和视神经管减压手术组（n = 33）。主要观察指标：视力。结果手术组32%、未治疗组57%、类固醇组52%的患者视力提高≥3线（P = 0.22）。手术组有更多的患者最初的视力是没有光感的。在基线视力调整后，任何治疗组之间没有显著差异。没有迹象表明皮质类固醇治疗的剂量或时间或手术时间与视力改善的可能性增加有关。结论皮质类固醇治疗或视神经管减压手术均无明显疗效。研究的患者数量足以排除治疗组的主要影响，尽管可能遗漏了特定亚组的临床相关影响。这些结果和现有文献提供了足够的证据表明，糖皮质激素和视神经管手术都不应被视为外伤性视神经病变患者的标准治疗方法。因此，根据个别患者的情况决定治疗或不治疗在临床上是合理的。
OBJECTIVETo compare the visual outcome of traumatic optic neuropathy treated with corticosteroids, treated with optic canal decompression surgery, or observed without treatment.DESIGNComparative nonrandomized interventional study with concurrent treatment groups.PARTICIPANTSA total of 133 patients with traumatic optic neuropathy (127 unilateral and 6 bilateral) who had an initial visual assessment within 3 days of injury. At least 1 month of follow-up was required for inclusion in the primary analysis.INTERVENTIONSOn the basis of treatment received within 7 days of injury, patients with unilateral injuries were categorized as being in one of three treatment groups: untreated (n = 9), corticosteroid (n = 85), or optic canal decompression surgery (n = 33).MAIN OUTCOME MEASUREVisual acuity.RESULTSVisual acuity increased by ≥3 lines in 32% of the surgery group, 57% of the untreated group, and 52% of the steroid group (P = 0.22). The surgery group had more patients whose initial vision was no light perception. After adjustment for the baseline visual acuity, there were no significant differences between any of the treatment groups. There was no indication that the dosage or timing of corticosteroid treatment or the timing of surgery was associated with an increased probability of visual improvement.CONCLUSIONSNo clear benefit was found for either corticosteroid therapy or optic canal decompression surgery. The number of patients studied was sufficient to rule out major effects in the treatment groups, although clinically relevant effects in specific subgroups could have been missed. These results and the existing literature provide sufficient evidence to conclude that neither corticosteroids nor optic canal surgery should be considered the standard of care for patients with traumatic optic neuropathy. It is therefore clinically reasonable to decide to treat or not treat on an individual patient basis.