CAJ | 학술논문

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:3～23 d.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8～23 d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.
목적 평개시신경감압술치료외상성시신경병변적효과.방법 회고성분석24례(24안)외상성시신경병변적림상자료.술전시력:무광감14안,광감8안,수지2안,소유환자술전균경당피질격소충격치료무효.대기중14례행경광사진로시신경감압술,10례행비내경하시신경감압술.수술거외상시간:3～23 d.술후관찰시력,수방2 ～ 24개월.결과 24례중17례유효,총유효솔70.8％.기중7례체0.05 ～0.8,현효솔29.1％.술전유잔여시력(광감～수지)자10례균유효,유효솔100％,기중6례술후체현효,점60％.무광감14례중,7례유효,유효솔50％,기중6례술후회복잔여시력,1례술후1년체0.2.상후3～7d무광감행수술감압자10례중유6례체도광감이상시력,유효솔60％,상후무광감8～23 d수술자4례중부유1례체광감,유효솔25％.결론 대외상성시신경병변당피질격소충격치료무효적병례,수술감압시안전유효적.술전유잔여시력자보수치료무효응적겁수술.무광감자일단학정수술응재1주내진조실시.
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,light perception in 8 eyes and counting finger in 2 eyes.Optic nerve decompression by orbital-ethmoidal sinus route were performed 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 acuity improved in 17 cases,the total effective rate was 70.8％.In which 7 cases visual acuities reached 0.05 to 0.8 (29.1％) ; All 10 patients with a residual vision ( light perception or counting fingers ) preoperatively 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 posttraumatic residual visions.For the patients with posttraumatic no light perception,optic nerve decompression should be performed within 3 -7 days after injury.