First Author: S.Churashov RUSSIA
Co Author(s): A. Kulikov S. Sosnovskii
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Traumatic optic neuropathy (TON) occurs, usually with a head injury, due to compression of a nerve in the optic canal, as well as in combined damage to the head, when the mechanical eye injury on the open or closed type combined with the midface trauma and head injury. Currently there is no common method of treatment TON. It can be an expectant management, decompress neurosurgical intervention, the use of high doses of synthetic glucocorticoids (SGCs), and a combination of these methods. Meaning TON as a factor influencing the functional outcome of optical-reconstructive vitreoretinal interventions for OGI is not well known.
To evaluate the effectiveness of systemic using SGCs as a method TON treatment in vitreoretinal surgery (VRS) over the open globe injuries (OGI) and formulate indications for their use.
The retrospective study included 328 patients with OGI (66.9% of all patients with a mechanical eye injury treated from 2010 to 2016 - 490). TON complicated the OGI in 46 patients (14%). All of them had indication to apply and performed VRS. Patients with TON after OGI were divided into two groups: - Group 1 - patients with OGI, who used SGCs before VRS (n = 10); - Group 2 - patients with OGI, which VRS was performed without treatment SGCs (n = 36). The first group was divided into three subgroups, depending on the time of initiation of therapy SGCs after receiving OGI: - subgroup A (n = 3) - less than 8 hours; - subgroup B (n = 3) - from 8 to 24 hours; - subgroup C (n = 4) - more than 24 hours. All patients underwent standard ophthalmic examination (visometry, perimetry, tonometry, ophthalmoscopy), electrophysiological study (ES and CFF), radiographic methods of research, consultation of specialists (otolaryngologist, neurosurgeon, neurologist, maxillofacial surgeon). All patients with TON were medicated conservatively and surgically by indication. Patients in Group 1 received SGCs intravenously as follows: 500 mg 2 times a day for 3 days. Daily dose was 1000 mg SGCs.
In Group 1 the improvement of VA was in 5 patients (50%). Increase VA was from 0.0026 at admission to 0.04 at discharge (p˂0.05). In Group 2 the improvement of VA was in 7 patients (20.5%), and VA increased from 0.003 at admission, up 0.01 at discharge (p˂0.05). VA in Group 1 after a vitrectomy in the background SGCs pulse therapy (PT) increased significantly more than in the 2nd group of unaccompanied treatment by SGCs (p˂0.05). The primary VA levels were similar in all groups (p> 0.05). When the SGCs PT was used for up to 8 hours of the injury after the VRS we observed significant increasing of VA up to 0.08 compared to the primary VA (p <0.05). In the event of the SGCs PT in a period of 8 to 24 hours of the injury after VRS we observed significant VA increasing up to 0.03 compared to primary VA (p <0.05). If the SGCs PT was started within the period of more than 24 hours after the trauma improvement in VA after the VRS was not significant (p>0.05). VA after VRS in the subgroup A was significantly greater than in the subgroup B (p <0.05).
TON is complication of OGI in 14% of cases. Timely using of high doses of SGCs after OGI with TON before VRS allows significantly improve the functional outcome of surgical treatment. Increasing visual functions after the VRS on OGI with TON is possible in case of using high doses of SGCs before surgery begins no later than 24 hours from the time of injury. The maximum effect is possible with early (up to 8 hours) beginning of treatment.