Optic Canal Decompression in Indirect Optic Nerve Trauma

Anesthesiology, 2006

Background Postoperative visual loss after prone spine surgery is increasingly reported in association with ischemic optic neuropathy, but its etiology is unknown. Methods To describe the clinical characteristics of these patients, the authors analyzed a retrospectively collected series of 93 spine surgery cases voluntarily submitted to the American Society of Anesthesiologists Postoperative Visual Loss Registry on standardized data forms. Results Ischemic optic neuropathy was associated with 83 of 93 spine surgery cases. The mean age of the patients was 50 +/- 14 yr, and most patients were relatively healthy. Mayfield pins supported the head in 16 of 83 cases. The mean anesthetic duration was 9.8 +/- 3.1 h, and the median estimated blood loss was 2.0 l (range, 0.1-25 l). Bilateral disease was present in 55 patients, with complete visual loss in the affected eye(s) in 47. Ischemic optic neuropathy cases had significantly higher anesthetic duration, blood loss, percentage of patients...

Objective: To investigate a possible correlation between final visual acuity and the presence at baseline of various systemic and local (orbital/ocular) signs in patients affected by indirect traumatic optic neuropathy. Methods: 35 cases of traumatic optic neuropathy were examined retrospectively and 13 variables were tested. Univariate analysis with " no recovery of visual acuity " as the primary outcome was performed. Relative risk (RR) and 95% confidence intervals (CI) were calculated. Fisher's exact test was used for two variables to test differences between proportions. Results: Four variables showed a significantly increased risk for no recovery of visual acuity: presence of blood within the posterior ethmoidal cells (RR = 2.25, 95% CI 1.25 to 4.04); age over 40 years (RR = 1.79, 1.07 to 2.99); loss of consciousness associated with traumatic optic neuropathy (RR = 2.21, 1.17 to 4.16); and absence of recovery after 48 hours of steroid treatment (p < 0.01, Fisher's exact test). Recovery documented at the first follow up visit after treatment was significantly associated with recovery at the last follow up visit (p < 0.01, Fisher's exact test). Conclusions: These four negative prognostic signs in patients affected by traumatic optic neuropathy may be useful in predicting the visual outcome in patients developing visual loss after head trauma and in deciding on the need for surgical treatment.

European Archives of Oto-Rhino-Laryngology, 2014

Post-traumatic optic neuropathy (TON) is a rare, but very much feared event. It is a traumatic injury of the optic nerve at any level along its course (often inside the optic canal), with partial or total loss of visual acuity, temporarily or permanently. Until now, an univocal treatment strategy does not exist. The clinical records of 26 patients, treated from 2002 to 2013, were reviewed. The most frequent cause of injury was road traffic accident (63 %), followed by iatrogenic damage, work injuries, sport or home accidents. All patients underwent pre-operative ophthalmological evaluation, neuro-imaging (angio-CT or angio-MRI scans) and systemic corticosteroid therapy. All patients required a surgical treatment, due to poor response to medical therapy; it consisted of an endonasal endoscopic decompression of the intracanalicular segment of the optic nerve, performed by removing the bony wall of the optical canal and releasing the perineural sheath. Improvement of visual acuity was reached in 65 % of cases. No minor or major complication occurred intra-or post-operative, with a maximum follow-up time of 41 months. An improvement in visual acuity was achieved, although very limited in some cases, when surgery was performed as close as possible to the traumatic event. In the literature, there is no evidencebased data evaluating both of the two main treatment options (medical therapy versus surgical decompression), to state which is the gold standard in the treatment for TON. We discuss the pro and cons of our protocol: medical endovenous steroid treatment, within 8 h of injury, and endoscopic surgical decompression within 12-24 since the beginning of medical therapy, represent the best solution in terms of risk-benefit ratio for the patients.

https://www.ijrrjournal.com/IJRR_Vol.7_Issue.11_Nov2020/Abstract_IJRR0027.html, 2020

Background: Traumatic cataracts pose a challenge to ophthalmologists, as they have an increased incidence of associated ocular abnormalities and intraoperative complications. Hence, astute surgical planning, careful surgical management and an intense post-operative follow up regime are imperative in the management of traumatic cataracts, to attain a reasonable visual outcome. The aim of the study was to investigate visual outcome of different treatment modalities of traumatic cataract. Methods: This prospective study was carried out on 50 patients in the Department of Ophthalmology, Government Medical College, Ernakulam, from January 2009 to December 2011. The different treatment modalities undertaken in the current study were Small Incision Cataract Surgery (SICS) and Posterior Chamber Intra Ocular Lens (PCIOL) Implantation, Lens aspiration and PCIOL implantation, SICS with Anterior Chamber Intra Ocular Lens (ACIOL), Lens removal, vitrectomy and primary ACIOL implantation, Intra Ocular Foreign Body (IOFB) removal, lens aspiration and ACIOL implantation, Lens removal and vitrectomy and SICS Implantation. Results: In the current study, SICS and Posterior Chamber Intra Ocular Lens (PCIOL) implantation was the most common operation (54%) performed. Out of 50, only 3 patients (6%) had a visual acuity of 6 /60 and 9(18%) had acuity of 6 /36. Three patients (6%) could achieve an acuity of 6/6. The patients who underwent SICS with PCIOL could achieve better overall visual acuity. Conclusion: The best visual outcome was obtained in patients who underwent SICS and PCIOL implantation. In our series 69.6% of patients could achieve acuity of 6/18 or more at the end of follow up.

Anesthesiology, 2002

Background The goal of this project was to describe the frequency and natural history of perioperative changes in vision. Methods The authors performed a prospective evaluation of changes in visual accommodation and acuity in adult patients undergoing various surgical procedures. Patients were evaluated preoperatively and at 1 and 3 days postoperatively. For patients who had persistent blurring of vision on the third postoperative day, surveillance was extended to 1.5 yr to determine how long the visual changes persisted and if the patients required eye-care provider attention for the condition. Results Twenty-eight of 671 patients (4.2%) reported new onset of blurred vision lasting at least 3 days after surgery. Seven of these 28 patients (1% of total) required either new corrective lens or changes in eyeglass or contact prescriptions because of persistent blurry vision. Most of the remaining patients reported resolution of blurry vision within 1 to 2 months. No significant risk fa...

International Journal of Current Science Research and Review

Objective: To determine if optic nerve decompression has any efficacy in patients with traumatic optic nerve (TON) damage specifically those patients whose optic nerves have been severely damaged and as a result, they suffer no light perception (NLP). Material & Methods: A retrospective study for group of 54 patients was observed for a period of between 3 to 12 months from 2020 to January 2021. Results: 35 patients still had no light perception at end of the study. By the time others were discharged some had gained a level or two of visual acuity but no cases of perfect vision restored were reported. Conclusion: The methods were relatively useful in reducing discomfort in patients such as significant reduction in swelling but they were not in any way completely responsible for the total recovery of the patients.

Otolaryngology - Head and Neck Surgery, 1999

The management of traumatic optic neuropathy remains controversial. In this report, we present the results of 45 patients treated with extracranial optic nerve decompression after at least 12 to 24 hours of corticosteroid therapy without improvement. Vision improved in 32 patients after surgery (71%), and the mean percentage of improvement from preoperative visual deficit was 40.7% ± 6.9% (median improvement 41.2%). Worsening of vision occurred in none of the patients as a result of the surgery, and no intraoperative or postoperative complications were encountered. We present a treatment protocol for traumatic optic neuropathy with the use of megadose corticosteroids and optic nerve decompression.

Journal of Anaesthesiology Clinical Pharmacology, 2012

Postoperative vision loss, a rare but devastating complication, has been reported after spine, cardiac, and head-neck surgeries. Its incidence following spine surgeries exceeds that after cardiothoracic surgeries. Various causes attributed to postoperative blindness include ischemic optic neuropathy, central or branch retinal artery occlusion, cortical blindness, and rarely external ocular injury. Other contributory factors described are microvascular diseases and intraoperative hemodynamic compromise. However, the exact association of these factors with postoperative blindness has not yet been confirmed. In this review, we describe causes, presentation, and treatment of postoperative blindness and also recommend practical guidelines to avoid this complication. The search strategies for this review included both search of electronic databases as well as manual search of relevant articles.

Ophthalmology, 2008

Journal of Neuroanaesthesiology and Critical Care

Perioperative visual loss (POVL) is a rare but potentially serious complication of long-duration surgeries in prone position under general anesthesia. The mechanism of visual loss after surgery, and its incidence, is difficult to determine. It is primarily associated with cardiothoracic and spine surgeries. The proposed causes include corneal injury, retinal ischemia (central retinal artery occlusion/branch retinal artery occlusion [CRAO/BRAO]), ischemic optic neuropathy (ION), and cortical blindness. A large, recent multicenter case-control study has identified risk factors associated with ION for patients undergoing spinal instrumentation surgery in prone position. These include male sex, obesity, use of Wilson&#39;s frame, long duration of anesthesia/surgery, larger estimated blood loss, and larger relative use of crystalloids for compensation of blood loss. This report describes a relatively healthy, 71-year-old female patient who developed significant visual impairment after th...