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Original Investigation | Clinical Sciences

Traumatic Optic Neuropathy and Second Optic Nerve Injuries

William Marshall Guy, MD1; Charles N. S. Soparkar, MD, PhD2,3,4,5,6; Eugene L. Alford, MD2; James R. Patrinely, MD4,5,6; Mirwat S. Sami, MD3,6; Robert B. Parke, MD1
[+] Author Affiliations
1Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
2Weill-Cornell College of Medicine, The Methodist Hospital, Houston, Texas
3Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
4Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
5Department of Plastic Surgery, Baylor College of Medicine, Houston, Texas
6Plastic Eye Surgery Associates, PLLC, Houston, Texas
JAMA Ophthalmol. 2014;132(5):567-571. doi:10.1001/jamaophthalmol.2014.82.
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Importance  Current controversy about the primary treatment of traumatic optic neuropathy (TON) has anchored on final vision following injury, but, to our knowledge, no study has examined the effect of different treatments on regaining and protecting optic nerve reserve or on the outcome of second optic nerve injuries.

Objective  To assess vision improvement in patients treated by various methods who have a second incidence of TON.

Design, Setting, and Participants  Retrospective medical record review of 12 patients with a second TON seen in an 18-year period (mean follow-up, 11.3 months) at a single tertiary care oculoplastic practice.

Interventions  Observation, high-dose corticosteroids, optic nerve decompression, or high-dose corticosteroids plus optic nerve decompression.

Main Outcomes and Measures  Change in vision on the Snellen eye chart.

Results  All second TON events involved the same-side optic nerve as initially injured, and with observation alone, corticosteroids, or corticosteroids and partial optic canal decompression, all patients had vision improvement after their initial injury (P = .004). However, following the second optic nerve injury, most patients’ vision fell to the pretreatment level of the first injury, and subsequent management of the second injury with corticosteroids and/or optic canal decompression provided little or no vision return (P = .05). In contrast, optic canal decompressions performed for 91 primary TON injuries resulted in 82.4% having some degree of vision improvement.

Conclusions and Relevance  Patients with TON may have a second optic nerve insult, and vision recovery from the second event may be limited regardless of primary treatment choice.

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