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Risk Factors Analysis for the Outcome of Indirect Traumatic Optic Neuropathy With Steroid Pulse Therapy

Lai, I-Li MD; Liao, Han-Tsung MD, PhD; Chen, Chien-Tzung MD

doi: 10.1097/SAP.0000000000000694
Clinical Papers

Background Although recent evidence suggests a controversy effect of steroids in the management of indirect traumatic optic neuropathy (TON), steroid pulse therapy remains one of the reasonable treatments for patients with indirect TON. It is thought that microcirculatory spasms, edema, and nerve cell necrosis can be prevented or reduced by large doses of steroids. The aim of this study is to analyze the predisposing factors for the recovery of patients with indirect TON who were treated with steroid pulse therapy.

Materials and Methods In tracing the 2008 to 2014 data from the Trauma Center of Chang Gung Memorial Hospital, 20 consecutive cases of indirect TON were identified retrospectively. Twenty cases showed no light perception (NLP) under initial ophthalmologic examination. They all received steroid pulse therapy with methylprednisolone in IV form after examination by ophthalmologists, and they did not receive optic nerve decompression. The general data, fracture pattern from images, hospital courses, trauma-related data from ER record, and the initial and final visual data from ophthalmologic records are reviewed. The odds ratio (OR) and 95% confidence intervals (CI) are calculated. Fisher exact test is used for 2 variables to test differences between proportions. Nonparametric statistics are applied to compare the mean values of the data.

Results The results show that for female patients (OR, 3.400; 95% CI, 1.628–7.101; P = 0.049), the administration of methylprednisolone in less than 24 hours from the injury (OR, 3.429; 0.297–39.637), lateral force fracture pattern (OR, 3.500; 0.313–39.153), age of 40 years or younger (OR, 2.333; 0.197–27.567), and pure facial trauma (OR, 3.667; 0.273–49.288) are the predisposing factors for improvement of visual acuity. Patients with orbital blowout fractures (OR, 9.800; 95% CI, 0.899–106.845; P = 0.070), initial free extraocular movement (EOM) (OR, 6.667; 0.809–54.597; P = 0.145), initial intraoptic pressure (IOP) greater than 25 mmHg (OR, 8.000; 0.598–106.936), and higher triage grade (OR, 3.000; 0.447–20.153) are at risk of showing no improvement.

Conclusions From this study, we might suggest to apply steroid pulse therapy on those patients without contraindication, with an incurring injury less than 24 hours previously. Factors such as sex, age, lateral force fracture pattern, and pure facial trauma revealed a better outcome for improvement of visual acuity. Orbital blowout fractures, initial free EOM, initial IOP greater than 25 mmHg, and higher triage grade suggested poor improvement of visual acuity.

From the *Department of Surgery, Chang Gung Memorial Hospital, LinKou, Taiwan, Republic of China; †Department of Plastic and Reconstructive Surgery, Craniofacial Center, Chang Gung Memorial Hospital, LinKou, Taiwan, Republic of China; and ‡Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Craniofacial Research Center, Keelung, Taiwan, Republic of China.

Received October 11, 2015, and accepted for publication, after revision October 26, 2015.

Conflicts of interest and sources of funding: none.

Reprints: Han-Tsung Liao, MD, PhD, Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine 5, Fu-Shing Street, Taoyuan 333, Taiwan, Republic of China. E-mail:

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