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Uludağ Ü. Göz Hastalıkları ABD., Bursa Purpose: To evaluate the efficacy of high dose intravenous corticosteroid treatment in traumatic optic neuropathy (TON)
Methods: The medical records of 9 patients (8 male, 1 female; age range, 4-69 years) who received high dose-corticosteroid treatment because of indirect TON, between January 1998 and May 2001, were reviewed. Optic neuropathy had developed as a result of traffic accident in 4 patients, falling from height in 3 patients, occupational injury in 1 patient, and firearm injury in 1 patient. Three patients had bilateral TON. At the time of diagnosis, the visual acuity ranged from 0.4 to hand movements in 9 eyes and 3 eyes had no light perception. Five patients received very-high-dose intravenous methylprednisolone treatment (2000-5000 mg/day), and 4 received high-dose treatment (1000 mg/day). The median duration between the visual loss and initiation of the treatment was 7 days (range: 1-60 days). The mean follow-up time was 4.5 months (range: 1-10 months).
Results: After treatment, the visual acuity improved in 8 of 12 eyes (67%) and remained unchanged in 4 eyes (33%). The light perception was negative at the time of diagnosis in 3 of the 4 eyes without visual improvement. The median time between the trauma and the initiation of the treatment was 5.5 days (range: 1-21 days) in the group of patients whose vision improved and 14 days in the group of patients whose vision did not change. No serious complication due to treatment developped in any patient.
Discussion: Superiority of either surgical or medical treatment methods over each other in indirect TON is controversial. In this limited study, high-dose intravenous methylprednisolone treatment yielded highly successful results. Corticosteroid therapy may not be helpful in eyes with TON with delayed treatment or without light perception at the time of diagnosis. Keywords : Traumatic optic neuropathy, high-dose corticosteroid, treatment