| Along with the changes of life style, living status and modern technologies developing in China as well ophthalmologists knowing more about the orbital trauma, the incidence of traumatic optic neuropathy (TON) seems to increase rapidly in recent few years. There were huge variances reported in route of injury, cause of blindness as well as degree of injury about visual acuities.There were fewer reports about the relationship between TON and co-exited orbital fractures. Accordingly, it's valuable to push a systematic research in this field controlled by ophthalmologists in an eye center with big amount of orbital trauma patients and ability of follow-up visit. PurposesFrom the ophthalmologist's points of view to systemically study the clinical epidemiological characteristics of TON patients in a well established university hospital eye center in Northeast China central city. The factors affacting the prognosis of visual acuities in TON patients should be collected by analyzing the characteristics of CT images, clinical features of TON patients co-exited with different types of orbital fractures, diagnosis and therapeutic principles.Retrospective study was applied in the TON patients, all the orbital fracture patients hospitalized at the same period and TON patients accompany to orbital fracture. Steroid and nasal endoscopic optic nerve decompression surgery and cranial route optic canal decompression are included in the therapia for TON patients. Data analysis were processed by contingency Chi square test. Results:(1) Effect of co-existing orbital fractures ant its morphological characters on the visual acuities before and after treatments:579 cases of orbital fracture are treated in our eye center in the same period, while 6.7% of which were accompanied with TON (39 cases).39 out of 66 eyes of TON were accompanied by different types of orbital fractures. The visual acuities in 20 of these 39 patients were NLP. LP/HM/CF were found 17 patients and only 2 out of 39 patients had the visual acuities over 0.05. In this group of the patients there were 8 patients with visual acuities improved after treatment. For the group of patients without co-exited orbital fractures, the visual acuities in 10 of 27 eyes were NLP and LP/HM/CF were found in 11 eyes. There were 6 patients with visual acuities over 0.05+. The visual acuities were found improved in 10 of these 27 eyes. The differences between the patients with and without co-existed orbital fractures were statistically significant.(2) The effects of types of co-existing orbital fractures on the visual acuities in the TON patients:21 out of 39 TON cases correlated orbital fractures were lateral orbital wall and the visual acuities were improved only in 2 eyes; But the 5 of the 19 TON cases with medial orbital wall correlated orbital fractures had their visual acuities improved; 21+19>39,?? The statistic results showed the difference between these 2 groups were significant.(3) Effects of time intervals between trauma and treatment on the visual outcome:5 of 30 cases accepted treatments within 3 days after injured and the visual acuities were improved obviously in 1 3 of whose patients; The rest of 36 cases accepted the treatments beyond 3 days after injured and only 6 of whose had the visual acuities improved; The statistic results showed the the difference between these 2 groups were significant.(4) The residual visual acuities before treatments affecting on the visual acuities:There were 2 of the 30 cases with NLP were improved; visual acuities were improved in 14 out of 27 cases with LP/HM/CF; There were 9 cases with the residual visual acuities over 0.05+and 3 of them had their visual acuities improved; Therfore the residual visual acuities do significantly affact the visual outcome in the TON patiens statistically.(5) The effects of therapeutic methods on the visual outcomes:13 of 38 cases who accepted steroid treatment had their visual acuity improved; The visual acuities were improved in 3 out of 13 cases who accepted nasal endoscopic optic nerve decompression surgery; Out former study result also showed that among the 30 cases who accepted cranial route optic canal decompression,10 of whose had their visual acuity improved. The statistic differences among these 3 ways of treatments in tersms of visual acuities were not significant.In Northern China the incidence of TON co-exited with orbital fractures among the orbital fractures was 6.7%;Visual acuities after injured in cases with orbital fractures were worse than that with no orbital fracture;The visual outcomes with orbital fracture were worse than those with no orbital fracture; And morphologically the prognosis of visual acuities in cases accompanied with lateral orbital wall correlated orbital fracture is worse than those with medial orbital wall correlated orbital fracture;The time intervals between trauma and treatments are critical to the TON patients. The visual outcomes in patients how accepted treatment within 3 days after injured are better than that beyond 3 days after injuries;The residual visual acuities are one of the key factors affecting the visual outcomes. The visual acuities in patients with NLP can barely be improved; The range of visual acuity improvements were broader in patients with LP/HM/CF; The improvements of visual acuities in patients with 0.05+ were much better than those patients with NLP and worse than that of LP/HM/CF;The evaluation on the therapeutica methods showed that there are no differences statistically in visual prognosis among steroid treatment, nasal endoscopic optic nerve decompression surgery and cranial route optic canal decompression. That result stated that no data suggested that one methods is better than others.
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