Wide Optic Nerve Canal Decompression for the Treatment of Blindness Resulting From an Indirect Optic Nerve Injury

Abstract

OBJECTIVE: The objective of this study was to investigate the efficacy of wide decompression of the optic canal for treating blindness resulting from an indirect optic nerve injury. METHODS: Forty-three patients with blindness resulting from an indirect optic nerve injury were retrospectively reviewed for preoperative vision, preoperative image, operative video, postoperative visual acuity, complications, and follow-up results. RESULTS: The 43 patients included 37 men and 6 women with an age range from 15 to 41 years (average, 31.8 years). On preoperative examination, all patients presented blindness in the involved eye. Six patients had an optic canal fracture. During the operation, a compression of the optic canal from a bony fragment was found in 1 patient, and an optic nerve sheath hematoma was found in another patient. After the operation, 6 patients developed cerebrospinal fluid rhinorrhea but recovered with conservative therapy. At the 6-month follow-up, visual acuity was improved to 3/60 in 3 patients, 5 patients could count fingers, 3 patients could see hand motions, and 3 patients retained light perception in the afflicted eye. The vision in other patients remained nonperceptive to light. CONCLUSIONS: Although the prognosis for blindness resulting from an indirect optic injury is poor, some patients have a chance to recover with enough decompression on the traumatized optic nerve. Poor results of this procedure may be related to the severity of the primary optic nerve injury.