The Management of Traumatic Optic Neuropathy: A Systematic Review and Meta-Analysis

Overview

Journal Arch Acad Emerg Med

Specialty Emergency Medicine

Date 2024 Dec 13

PMID 39670238

Authors

Mohammad Fallahzadeh

Amirreza Veisi

Faezeh Tajari

Zahra Khorrami

Mehri Farhang Ranjbar

Roozbeh Tavanaei

Navid Ghassembaglou

Seyed Hadi Aghili

Affiliations

Soon will be listed here.

Abstract

Introduction: Traumatic optic neuropathy (TON) is a serious condition resulting from optic nerve injury, often due to head trauma. This study systematically reviews the existing literature to evaluate the effectiveness of various treatments in improving visual outcomes in TON patients.

Methods: A comprehensive literature search was conducted across databases including Medline (via PubMed), Web of Science, Cochrane Library, and EMBASE from January 1992 to October 2024. Studies were selected based on inclusion criteria that focused on TON patients treated with corticosteroids, conservative therapy, erythropoietin therapy, or surgical interventions. Quality assessment of the included studies was performed using the Joanna Briggs Institute (JBI) Risk of Bias Tool for each design. Data extraction and quality assessment were performed by two independent reviewers, with a meta-analysis conducted to evaluate the pooled visual acuity (VA) improvement rates.

Results: A total of 23 studies were included, encompassing 1,851 patients with TON. The meta-analysis revealed a pooled VA improvement rate of 50.6% across all treatment modalities. Specifically, corticosteroid-only treatment resulted in a 56.2% improvement rate, while combined corticosteroid and surgical decompression showed a 42.9% improvement rate. Conservative therapy had a 47.8% improvement rate. The heterogeneity among studies was significant (I= 89.9%), and no significant publication bias was detected. Subgroup analyses indicated varied outcomes, with some studies reporting better results with early intervention.

Conclusion: The treatment of TON remains challenging, with no single modality showing clear superiority. The corticosteroids and surgical interventions provide potential benefits; however, conservative therapy might be appropriate for certain cases. Future research should focus on optimizing treatment protocols and exploring new therapeutic options, such as erythropoietin to improve visual outcomes in TON patients.

References

Sosin M, De La Cruz C, Mundinger G, Saadat S, Nam A, Manson P . Treatment Outcomes following Traumatic Optic Neuropathy. Plast Reconstr Surg. 2015; 137(1):231-238. DOI: 10.1097/PRS.0000000000001907. View

Barker T, Stone J, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J . The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synth. 2023; 21(3):494-506. DOI: 10.11124/JBIES-22-00430. View

Rajiniganth M, Gupta A, Gupta A, Bapuraj J . Traumatic optic neuropathy: visual outcome following combined therapy protocol. Arch Otolaryngol Head Neck Surg. 2003; 129(11):1203-6. DOI: 10.1001/archotol.129.11.1203. View

Mine S, Yamakami I, Yamaura A, Hanawa K, Ikejiri M, Mizota A . Outcome of traumatic optic neuropathy. Comparison between surgical and nonsurgical treatment. Acta Neurochir (Wien). 1999; 141(1):27-30. DOI: 10.1007/s007010050262. View

Sefi-Yurdakul N, Koc F . Risk factors affecting the visual outcome in patients with indirect traumatic optic neuropathy. Int Ophthalmol. 2017; 38(4):1647-1652. DOI: 10.1007/s10792-017-0637-9. View

Gao Y, Li J, Ma H, Nie C, Lv X, Lin X . Endoscopic trans-ethmosphenoid optic canal decompression is an optimal choice to save vision for indirect traumatic optic neuropathy. Acta Ophthalmol. 2021; 100(2):e491-e501. PMC: 9290745. DOI: 10.1111/aos.14951. View

Cook M, Levin L, Joseph M, Pinczower E . Traumatic optic neuropathy. A meta-analysis. Arch Otolaryngol Head Neck Surg. 1996; 122(4):389-92. DOI: 10.1001/archotol.1996.01890160031006. View

Kashkouli M, Yousefi S, Nojomi M, Soltan Sanjari M, Pakdel F, Entezari M . Traumatic optic neuropathy treatment trial (TONTT): open label, phase 3, multicenter, semi-experimental trial. Graefes Arch Clin Exp Ophthalmol. 2017; 256(1):209-218. DOI: 10.1007/s00417-017-3816-5. View

Chen B, Zhang H, Zhai Q, Li H, Wang C, Wang Y . Traumatic optic neuropathy: a review of current studies. Neurosurg Rev. 2022; 45(3):1895-1913. DOI: 10.1007/s10143-021-01717-9. View

10.

Samardzic K, Samardzic J, Janjetovic Z, Samardzic I, Sekelj S, Latic-Hodzic L . Traumatic optic neuropathy - to treat or to observe?. Acta Inform Med. 2013; 20(2):131-2. PMC: 3544324. DOI: 10.5455/aim.2012.20.131-132. View

11.

Pokharel S, Sherpa D, Shakya K, Shrestha R, Malla O, Pradhananga C . Visual Outcome after Treatment with High Dose Intravenous Methylprednisolone in Indirect Traumatic Optic Neuropathy. J Nepal Health Res Counc. 2016; 14(32):1-6. View

12.

Barker T, Habibi N, Aromataris E, Stone J, Leonardi-Bee J, Sears K . The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evid Synth. 2024; 22(3):378-388. DOI: 10.11124/JBIES-23-00268. View

13.

Emanuelli E, Bignami M, Digilio E, Fusetti S, Volo T, Castelnuovo P . Post-traumatic optic neuropathy: our surgical and medical protocol. Eur Arch Otorhinolaryngol. 2014; 272(11):3301-9. DOI: 10.1007/s00405-014-3408-5. View

14.

Mauriello J, DeLuca J, Krieger A, Schulder M, Frohman L . Management of traumatic optic neuropathy--a study of 23 patients. Br J Ophthalmol. 1992; 76(6):349-52. PMC: 504284. DOI: 10.1136/bjo.76.6.349. View

15.

Yu-Wai-Man P . Traumatic optic neuropathy-Clinical features and management issues. Taiwan J Ophthalmol. 2015; 5(1):3-8. PMC: 4457437. DOI: 10.1016/j.tjo.2015.01.003. View

16.

Lai Y, Lin T, Ho P, Chen Y, Huang Y, Lu D . Erythropoietin in Optic Neuropathies: Current Future Strategies for Optic Nerve Protection and Repair. Int J Mol Sci. 2022; 23(13). PMC: 9267007. DOI: 10.3390/ijms23137143. View

17.

Hsieh C, Kuo Y, Hung H, Tsai H, Jeng S . Indirect traumatic optic neuropathy complicated with periorbital facial bone fracture. J Trauma. 2004; 56(4):795-801. DOI: 10.1097/01.ta.0000071298.97591.60. View

18.

Kountakis S, Maillard A, Longhini L, Urso R . Endoscopic optic nerve decompression for traumatic blindness. Otolaryngol Head Neck Surg. 2000; 123(1 Pt 1):34-7. DOI: 10.1067/mhn.2000.106007. View

19.

Wei W, Zhao S, Li Y, Zhang J, Wu J, Liu H . The outcome of surgical and non-surgical treatments for traumatic optic neuropathy: a comparative study of 685 cases. Ann Transl Med. 2022; 10(10):542. PMC: 9201174. DOI: 10.21037/atm-22-1836. View

20.

Yu-Wai-Man P, Griffiths P . Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev. 2013; (6):CD006032. PMC: 7390489. DOI: 10.1002/14651858.CD006032.pub4. View