High-dose steroid therapy of traumatic optic neuropathy may fail to protect the optic nerve permanently

1999 ◽  
Vol 21 (4) ◽  
pp. 255-260 ◽  
Author(s):  
Zofia Mariak ◽  
Iwona Obuchowska ◽  
Zenon Mariak ◽  
Andrzej Stankiewicz ◽  
Andrzej Ustymowicz ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Steroid Therapy ◽  
Optic Neuropathy ◽  
High Dose ◽  
Traumatic Optic Neuropathy ◽  
High Dose Steroid

scholarly journals Endoscopic optic nerve decompression in traumatic optic neuropathy: our experience in a tertiary care centre

2021 ◽  
Author(s):  
Bincy Joseph ◽  
Sapna S. Nambiar ◽  
K. Ramachandran ◽  
Suma Radhakrishnan
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
High Dose ◽  
Time Interval ◽  
Traumatic Optic Neuropathy ◽  
High Dose Steroid ◽  
Nerve Decompression ◽  
Prompt Treatment ◽  
Optic Nerve Decompression

<p><strong>Background: </strong>Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnosis and prompt treatment. High dose steroid injections, optic nerve decompression or combined therapy are the available current treatment options. This study aims to determine the visual outcome with transnasal endoscopic optic nerve decompression in patients with TON having no improvement in vision despite high dose steroids.</p><p><strong>Methods:</strong> A prospective study was conducted at the department of ENT, government medical college Kozhikode; on patients who presented with loss of vision following history of trauma. All patients suspected of compressive optic neuropathy received injection methyl prednisolone (30 mg/kg/day) with assessment of vision and HRCT scan. Patients with deterioration or no improvement in vision despite high steroid therapy were taken up for trans-nasal endoscopic optic nerve decompression.</p><p><strong>Results:</strong> In our study 19 patients with TON underwent trans-nasal endoscopic optic nerve decompression. 11(57.9%) patients had improvement of vision, 7 (36.8%) patients had no improvement of vision and 1 (5.3%) patient had worsening of vision. The visual improvement was seen in 8 (80%) patients when treatment was initiated within 7 days and in only 3(33.3%) patients when treatment was initiated after 7 days. The visual acuity at presentation and time interval between trauma and intervention are factors that determine better visual outcomes.</p><p><strong>Conclusions:</strong> The decreased visual acuity in TON requires prompt treatment. High dose steroid must be started at once when it is suspected or diagnosed. The timely surgical intervention with trans-nasal endoscopic optic nerve decompression is a relatively safe and effective technique enabling better visual prognosis.</p>

The Effects of High-Dose Corticosteroid Therapy on Optic Nerve Head Blood Flow in Experimental Traumatic Optic Neuropathy

1999 ◽  
Vol 31 (6) ◽  
pp. 463-470 ◽  
Author(s):  
Helen Lew ◽  
Sang Yeul Lee ◽  
Jae Woo Jang ◽  
Hye Young Kim ◽  
Shin Jeong Kang ◽  
...  
Keyword(s):  
Blood Flow ◽  
Optic Nerve ◽  
Corticosteroid Therapy ◽  
Optic Neuropathy ◽  
Optic Nerve Head ◽  
High Dose ◽  
Traumatic Optic Neuropathy ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

scholarly journals A Systematic Literature Review on Traumatic Optic Neuropathy

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Saeed Karimi ◽  
Amir Arabi ◽  
Iman Ansari ◽  
Toktam Shahraki ◽  
Sare Safi
Keyword(s):  
Optic Nerve ◽  
Head Trauma ◽  
Optic Neuropathy ◽  
High Dose ◽  
Traumatic Optic Neuropathy ◽  
Efficient Treatment ◽  
High Dose Corticosteroid ◽  
Pupillary Constriction ◽  
Dose Corticosteroid ◽  
Mechanical Shearing

Traumatic optic neuropathy (TON) is an uncommon vision-threatening disorder that can be caused by ocular or head trauma and is categorized into direct and indirect TON. The overall incidence of TON is 0.7–2.5%, and indirect TON has a higher prevalence than direct TON. Detection of an afferent pupillary defect in the presence of an intact globe in a patient with ocular or head trauma with decreased visual acuity strongly suggests TON. However, afferent pupillary defects may be difficult to detect in patients who have received narcotics that cause pupillary constriction and in those with bilateral TON. Mechanical shearing of the optic nerve axons and contusion necrosis due to immediate ischemia from damage to the optic nerve microcirculation and apoptosis of neurons is a probable mechanism. The proper management of TON is controversial. High-dose corticosteroid therapy and decompression of the optic nerve provide no additional benefit over observation alone. Intravenous erythropoietin may be a safe and efficient treatment for patients with TON.

Mediastinal lipomatosis: a complication of high dose steroid therapy in children

1988 ◽  
Vol 19 (1) ◽  
pp. 57-58 ◽  
Author(s):  
L. W. Shukla ◽  
J. A. Katz ◽  
M. L. Wagner
Keyword(s):  
Steroid Therapy ◽  
High Dose ◽  
High Dose Steroid

scholarly journals Simultaneous Bilateral Femoral Neck Fracture Due to a Tonic-Clonic Seizure and High-Dose Steroid Therapy

2020 ◽  
Vol 6 (3) ◽  
pp. 513-516
Author(s):  
Fernando Diaz Dilernia ◽  
Martin M. Estefan ◽  
Gerardo Zanotti ◽  
Fernando Comba ◽  
Francisco Piccaluga ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Steroid Therapy ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
High Dose ◽  
High Dose Steroid ◽  
Neck Fracture

scholarly journals Exosome-Mediated Delivery of the Neuroprotective Peptide PACAP38 Promotes Retinal Ganglion Cell Survival and Axon Regeneration in Rats With Traumatic Optic Neuropathy

2021 ◽  
Vol 9 ◽  
Author(s):  
Tian Wang ◽  
Yiming Li ◽  
Miao Guo ◽  
Xue Dong ◽  
Mengyu Liao ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Ganglion Cell ◽  
Retinal Ganglion Cell ◽  
Optic Neuropathy ◽  
Axon Regeneration ◽  
Retinal Ganglion ◽  
Traumatic Optic Neuropathy ◽  
Fiber Layer

Traumatic optic neuropathy (TON) refers to optic nerve damage caused by trauma, leading to partial or complete loss of vision. The primary treatment options, such as hormonal therapy and surgery, have limited efficacy. Pituitary adenylate cyclase-activating polypeptide 38 (PACAP38), a functional endogenous neuroprotective peptide, has emerged as a promising therapeutic agent. In this study, we used rat retinal ganglion cell (RGC) exosomes as nanosized vesicles for the delivery of PACAP38 loaded via the exosomal anchor peptide CP05 (EXOPACAP38). EXOPACAP38 showed greater uptake efficiency in vitro and in vivo than PACAP38. The results showed that EXOPACAP38 significantly enhanced the RGC survival rate and retinal nerve fiber layer thickness in a rat TON model. Moreover, EXOPACAP38 significantly promoted axon regeneration and optic nerve function after injury. These findings indicate that EXOPACAP38 can be used as a treatment option and may have therapeutic implications for patients with TON.

Outcomes of Steroid Therapy in Combination with Endoscopic Optic Nerve Decompression Surgery for Direct Traumatic Optic Neuropathy: A Case-Series

2021 ◽  
Vol 104 (7) ◽  
pp. 1166-1171
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Poor Prognosis ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
Case Series ◽  
Light Perception ◽  
Traumatic Optic Neuropathy ◽  
Nerve Decompression

Background: Direct traumatic optic neuropathy (TON) carries a poor prognosis. However, the outcome of this injury is diverse and is related to time to treatment and treatment protocol. Objective: To evaluate the outcomes of the combined treatment protocol in patients with direct TON. Materials and Methods: The authors retrospectively reviewed the medical records of patients between January 2015 and August 2019. Main outcome was visual acuity (VA) improvement after the treatment. Results: Thirteen patients (15 eyes) were included. The mean age was 38.61 years with a range of 13 to 65 years. Initial VA varied from no light perception (NPL) in seven eyes of six patients, light perception (PL) in one eye, counting fingers in two eyes, 20/200 in three eyes, and 20/60 in two eyes. Average timing to treatment was 2.8 days (range 0 to 7 days). There were no side effects of high-dose corticosteroids treatment in all patients. During a follow-up period of three months, six of 13 patients (46.1%) had VA improvement. Conclusion: Despite poor prognosis of direct TON, the combined treatment protocol provides a favorable successful rate with most patients on having stable vision, and some having visual improvement from reducing intracanalicular pressure of the optic nerve. Keywords: Endoscopic optic nerve decompression; Traumatic optic neuropathy; Visual acuity; Case series

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