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Visual prognosis after indirect traumatic optic neuropathy

¹ Department of Ophthalmology, University of Parma, Parma, Italy
² Department of Ophthalmology, University of Sassari, Sassari, Italy
³ Department of Ophthalmology, University of Milan, Milan, Italy
⁴ Department of Ophthalmology, University of Brussels, Brussels, Belgium
⁵ Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy
⁶ Department of Opthalmology, University of Sassari, Sassari, Italy

Correspondence to:
Correspondence to:
Dr Arturo Carta, Neuro-Ophthalmology Service, Department of Ophthalmology, University of Parma, via Gramsci 14, 43100 Parma, Italy;
acarta{at}unipr.it

ABSTRACT
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.

Keywords: closed head trauma; traumatic optic neuropathy; visual loss; visual prognosis