视神经减压术治疗外伤性视神经病变  

Therapeutic efficacy of optic nerve decompression on traumatic optic neuropathy

作　　者：李珍[1] 岳靓[1] 李筱勇[2] 镡鲁滨[1] 孙忠亮[2] 

机构地区：[1]解放军第401医院眼科,山东青岛266071 [2]解放军第401医院耳鼻喉科, 山东青岛266071

出　　处：《中华眼外伤职业眼病杂志》2012年第6期406-408,共3页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评价视神经减压术治疗外伤性视神经病变的效果。方法回顾性分析24例（24眼）外伤性视神经病变的临床资料。术前视力：无光感14眼，光感8眼，数指2眼，所有患者术前均经糖皮质激素冲击治疗无效。对其中14例行经眶筛进路视神经减压术，10例行鼻内镜下视神经减压术。手术距外伤时间：3～23d。术后观察视力，随访2～24个月。结果24例中17例有效，总有效率70．8％。其中7例达0．05～0．8，显效率29．1％。术前有残余视力（光感～数指）者10例均有效，有效率100％，其中6例术后达显效，占60％。无光感14例中，7例有效，有效率50％，其中6例术后恢复残余视力，1例术后1年达0．2。伤后3～7d无光感行手术减压者10例中有6例达到光感以上视力，有效率60％，伤后无光感8～23d手术者4例中仅有1例达光感，有效率25％。结论对外伤性视神经病变糖皮质激素冲击治疗无效的病例，手术减压是安全有效的。术前有残余视力者保守治疗无效应积极手术。无光感者一旦确定手术应在1周内尽早实施。Objective To evaluate the therapeutic efficacy of optic nerve decompression in patients with traumatic optic neuropathy （TON）. Methods In a retrospective study, the clinical data of 24 consecutive patients （24 eyes） with TON treated with optic nerve decompression after failure of mega-dose steroid therapy were analyzed. Preoperative visual acuities were no light perception in 14 eyes, fight perception in 8 eyes and counting finger in 2 eyes. Optic nerve decompression by orbital-ethmoidal sinus route were per- formed in 14 cases, and 10 cases were treated by transnasal endoscopic optic nerve decompression. Their visual outcomes were summarized after follow-up for 2 - 24 months. Results In total 24 patients, visual a- cuity improved in 17 cases , the total effective rate was 70.8%. In which 7 cases visual acuities reached O. 05 to O. 8 （29.1%） ; All 10 patients with a residual vision （ light perception or counting fingers ） preop- eratively showed improvement of their visual acuities （ 100% ）. In 14 patients with posttraumatic blindness, visual acuities improved in 7 cases （50%）. Decompression was performed within 3 -7 days after injury in 10 cases with posttraumatic blindness, visual acuities improved in 6 cases （60%） . But decompression was performed within 8 - 23 days after injury in 4 cases with posttraumatic blindness, visual acuity improved in 1 cases （25 % ） . Conclusion Optic nerve decompression is an effective and safe treatment for patients with TON after failure of mega-dose steroid therapy . The surgery is indicated for the patients with some posttrau- matic residual visions. For the patients with posttraumatic no light perception, optic nerve decompression should be performed within 3 -7 days after injury.

关 键 词：视神经损伤 治疗 减压术 

分 类 号：R779.1[医药卫生—眼科]