Outcome of Endoscopic Decompression of Optic Nerve for Traumatic Optic Neuropathy

INTRODUCTION: Traumatic optic neuropathy is a serious vision threatening complication of ocular or head injuries. Traumatic loss of visual function, which can present as subnormal visual acuity, visual field loss, or colour vision dysfunction, is the characteristic of optic neuropathy. The presence of an afferent pupillary defect strongly shows that the injury occurred prechiasmally and is required to confirm the diagnosis of traumatic optic neuropathy. Traumatic optic neuropathy can cause partial or complete vision loss, which can be transient or permanent. The patient may benefit more from early identification and treatment of traumatic optic neuropathy. The presence of an absolute or relative afferent pupillary defect, as well as disc edema and vascular congestion, aid in diagnosing an optic nerve deficit. These findings, when combined with the computed tomography (CT) scan, perhaps an MRI scan, and visual evoked potentials, may be sufficient to proceed with optic nerve decompression. AIM OF THE STUDY: To analyse the outcome of endoscopic optic nerve decompression and prognosis in traumatic optic neuropathy patients attending Tirunelveli Medical College Hospital. MATERIALS AND METHODS: A prospective study on the outcome of endoscopic optic nerve decompression in traumatic optic neuropathy patients admitted in Tirunelveli Medical College Hospital was conducted in department of ENT, Tirunelveli Medical College Hospital. This study was conducted from period of January 2020 to December 2021.All eligible traumatic optic neuropathy neuropathy patients as per inclusion criteria were included in the study. INCLUSION CRITERIA: Both male and female patients of all age group, diagnosed as traumatic optic neuropathy, who have given consent for endoscopic optic nerve decompression were included in the study. EXCLUSION CRITERIA: Unconscious patients, patients who haven’t given consent for the surgery were excluded from the study. METHODOLOGY: After getting approval from institutional ethical committee, patients satisfying the above inclusion criteria were included in the study after getting informed consent. Preoperatively, all basic investigations including CBC, RBS,RFT, serum electrolytes, chest x ray, ECG were done. Detailed ocular examinations including visual acuity, colour vision, pupillary reaction, visual field examinations, fundus examinations were done. All patients were started on Inj. Methyl prednisolone IV at dose of 1g/day for 3 days followed by T. Prednisolone 1 mg/kg for a period of 11 days and tapered there after. After getting informed written consent from patients, and after stabilizing patients general condition, the patients were taken for endoscopic traumatic optic nerve decompression under general anaesthesia. CONCLUSION: ❖ Endoscopic endonasal optic nerve decompression have a significant effect in visual acuity improvement in traumatic optic neuropathy. ❖ Results are better if endonasal optic nerve decompression is carried out as early as possible. ❖ Minimal Improvement is reported in patients even if the surgery is carried out after 7 days. Hence no patients should be denied of this surgery even in such delayed circumstances. ❖ Results are better in patients having some residual vision pre-operatively than in totally blind patients