Clinical Efficiency And Analysis Of Prognostic Factors Of Endoscopic Optic Nerve Decompression In Traumatic Optic Neuropathy

Objective:Traumatic optic neuropathy (TON) is an important cause of severe loss of vision due to blunt or penetrating head trauma. To meet the needs of the clinical operation, we investigate the therapeutic efficacy of endoscopic optic nerve decompression (EOND) in the treatment of TON and evaluate the relevant prognostic factors with visual acuity.Methods:A retrospective study was conducted to analyze the clinical characteristics and prognosis of 62 TON cases in the second hospital of Jilin University. Among the 62 cases, there are 57 males and 6 female; age ranges from 11 to 68;visual acuity before treatment ranges from no light perception to finger counting; the time from injury to surgery ranges from 5 days to 73 days.1) Comparisons were made between groups with light perception at least and without light perception using independent sample t-test.2) 31 cases of blindness patients were divided into four groups:0-7 days,8-14 days,15-21 days and more than 21 days were compared using fisher exact test.3) 31 cases of light perception at least were divided into three groups:light perception, hand motion and finger counting were compared using fisher exact test.4) The prognostic factors,regarding the time interval between trauma and surgery, the pupil size, no light perception(NLP), visual acuity improved after drug therapy,optic canal fracture, complications as independent variable(X), and the curative effects as dependent variable(Y), carries on nonconditional multiple logistic regression analysis to evaluate potential prognostic factors.Results:1.The overall rate of EOND effectiveness was 40.3%. A significantly higher effective rate(51.6%) was observed for patients with light perception at least compared with those without light perception(29.0%),p=0.041<0.05).2.Among the patients without light perception, there was no significant difference(p=1.0>0.05) identified between the four groups:5 cases during 0-7 days,14 cases during 8-14 days,5 cases during 15-21 days and 7 cases more than 21 days.3.Among the visual acuity with light perception at least, there is no difference(p=1.0>0.05) between 9 patients with light perception,12 patients with hand motion and 10 patients with finger counting.4.Nonconditional multiple logistic regression analysis identified four variables that were significantly associated with visual acuity prognosis. Light perception at least after trauma(OR=0.851, p=0.035), visual acuity improved after drug therapy(OR=0.700, p=0.045) are positive factors. The time interval between trauma and surgery(OR=5.753, p=0.020), the pupil size(OR=1.437, p=0.031) are risk factors.Conclusion:1.Therapeutic effect of surgical treatment on patients with light perception at least is better than without light perception.2.The factors that impact TON prognoses are complex,while the indication for EOND should be individualized.Patients who can gain visual acuity improved after drug therapy will have a better prognosis..3.Although 31 patients without light perception, there was still almost one-third patients could improved after surgery. Endoscopic optic nerve decompression is an effective technique in treatment with traumatic optic neuropathy.