Projects

Background: Optic nerve injuries occur in the setting of head injury which is often a consequence of road traffic accidents or falls. Traumatic optic neuropathy (TON) is an important cause of functional impairment of vision. Different treatment approaches like different dosages of steroids, surgical decompression and observation alone have been suggested but there has been no conclusive evidence to establish a standard approach to this devastating cause of visual loss. Aim: To determine the effectiveness of intravenous (IV) methylprednisolone in the treatment of patients with traumatic optic neuropathy. Materials and Methods: An observational clinical study. Nine patients, all male with a mean age of 39.1 (14 to 55 years) were enrolled. All patients received 1 g of IV methylprednisolone for 3 days followed by 1 mg/kg oral prednisolone in tapering dose over 2 weeks. Paired proportion test has been used to find out the significance of patients with >=2 line improvement of visual acuity from base line visual acuity after treatment. Results: The data of 9 patients (12 eyes) were analysed.Ten out of twelve eyes had poor visual acuity (<=6/60). Visual acuity was ranging from 6/36 to 6/6 in 8 patients 1 month post treatment, of which those between 6/6-6/9 was seen to be statistically significant (p=0.061). Patients with initial visual acuity (pre-treatment) of counting fingers or better had > 2 line improvement in Snellen’s chart 1 month post treatment which was statistically significant (p=0.045). Though 6 out of 7 patients with very poor vision (NLP, PL, HM) had >=2 line improvement, it was not statistically significant. Conclusion: Patients with traumatic optic neuropathy who had vision better than counting fingers showed significant improvement after treatment with methylprednisolone but those with very poor vision did not show statistically significant improvement. Keywords: Extra ocular muscle palsy, Methylprednisolone, Traumatic optic neuropathy, Vehicular accidents