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Incidence of optic canal fracture in the traumatic optic neuropathy and its effect on the visual outcome
  1. Wentao Yan2,
  2. Yingbai Chen3,
  3. Zhenbin Qian2,
  4. Dinesh Selva4,
  5. Daniel Pelaez5,
  6. Yunhai Tu2,
  7. Wencan Wu1
  1. 1Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
  2. 2Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, PR China
  3. 3Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
  4. 4Discipline of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia
  5. 5Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Professor Wencan Wu, Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, No. 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, P. R. China; wuwencan118{at}163.com

Abstract

Objective To correlate the intraoperative endoscopic findings with high-resolution CT (HRCT) for the diagnosis of optic canal fractures (OCF). To compare the visual outcome of patients with different types of OCF and without.

Design A retrospective, comparative case series.

Participants 1275 consecutive patients (1275 eyes) with indirect traumatic optic neuropathy (TON).

Methods Altogether, 1275 patients who underwent endoscopic transethmoid optic canal decompression (ETOCD) for unilateral indirect TON were reviewed from 1 October 2006 to 30 September 2014. HRCT performed prior to surgery were compared with findings during surgery. The visual outcomes before and after surgery were also compared.

Main outcome measures The presence and type of OCF detected by HRCT and during surgery; visual acuity prior to surgery and at 3 months after surgery.

Results A total of 1275 patients (1275 eyes) were included, with 708 patients that had OCF visible on HRCT image. During surgery, an additional 187 (20.9%) patients with OCF were noticed. Among these, 136 had undisplaced fractures, most of which were linear intracanalicular fractures. The initial visual acuity of patients with OCF was worse than that of patients without OCF (p<0.01). However, no statistical difference existed in the final visual acuity at 3 months after surgery (>0.05). Significant statistical difference of surgical efficacy existed between all the patients with OCF and without OCF (p<0.001).

Conclusions Among patients with OCF, 20.9% were not detected by HRCT. Patients with OCF had a worse initial visual acuity than those without OCF. There was no significant difference in final visual acuity after ETOCD.

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