The clinical investigation of the treatment of traumatic optic nerve injury

Objectives: The trauma induced vision impairment often be concomitant with canial complications and has unfavorable prognosis. To date, no unified standard has been established for the treatment of traumatic optic nerve injury, which impedes the academic communication. In this study, we investigated the new standard for the diagnosis and treatment of such cases.
Methods: 129 inpatients with traumatic optic nerve injury were retrospectively investigated: (1) 104 cases with orbital fracture and paranasal sinuses hematocele, includin 48 LS(+) patients, 56 HM patients. All patients underwent orbital reconstruction+hematocele clearence+medicine application treatment. (2) 25 patients with precise trauma history. In these 25 cases, no orbital fracture and paranasal sinuses hematocele was found with 3D-CT, including 19 HM patients, 6 LS(-) patients. Only medicine treatment was applied on these cases.
Results: (1) The VA has significant improvement in operation+medicine treatment group. The VA improved to 0.02 in 29 patients, 0.1-0.4 in 55 patients,>0.04 in 20 patients. (2) In non-orbital fracture patients treated with medicine only, the VA of 5 LS(-) patients improved to 0.02; 4 patients maintain LS(-). The VA of 12 HM patients improved to 0.1-0.4, 4 HM patients to 0.6.
Conclusion: Orbital, ocular, canial injury, including canial cursh injury, can induce canial base fracture, paranasal sinuses hematocele, which in turn lead to optic nerve injury. No principle can be followed to date due to the vary clinical symptoms. The therapy of traumatic optic nerve injury is a comprehensive inter-principle issue. The combination of typical symptoms, high resolution CT and angiography is a relatively reliable method for diagnosis and treatment. The parameters for MRI detection of optic nerve injury should be investigated in the future study. The standard indicators for diagnosis and prognosis need to be further explored. Operation should be applied within 1 week in patients have remnant vision and better VA after 3-5 days medicine treatment. The saving of visual function should be on the basis of life safety and co-operation of relative departments, Misdiagnosis can be partly avioded with appropriate differentiation of optic nerve injury and simple cerebral contusion.The therapy strategy can be established based on the results of imaging, identification of injury location, area, and condition of adjacent tissue. The decompression of optic canal under nasal endoscope is carrying on in our department. The Mouse Nerve Growth Factor can enhance the recovery of injuried optic nerve. In summary, no favorable therapy strategy has been established to date. The results of our study indicate that labor safety and protection should be emphasized by government, and the fundmental point of optic nerve injury issue is to avoid the occurrence of injury. Viewpoints mentioned in this study are personal suggestion, for your reference only.