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治療外傷性視神經病變之臨床經驗－續報
Clinical Experience in the Management of Traumatic Optic Neuropathy-Second Report
摘要
本研究自民國75年至民國80年總計60例外傷性視神經病變志者提出報告。其中10例僅嚴密觀察其臨床症狀，未給予任何治療，作為對照組。50例患者接受口服prednisolone (60-100mg/day)或靜脈注射大劑量dexamethasone (1-3mg/kg/day)類固醇。其中26例於藥物治療後接受視神經管減壓術，2例經上頜竇，20例經眼眶，4例經顱內。 對照組中並無明顯現力進步。藥物治療組中，18例有視力進步(36%)；手術治療組中，13例視力進步(50%)。如果患者於受傷後仍有殘存視力，其預後較受傷沒完全沒有視力者為佳（藥物治療組之進步率分別為57%比21%；手術治療組之進步率分別為78%比35%）。此外根據電腦斷層資料顯示，13例(22%)有視神經管骨折。骨折部位均位於視神經管內壁。此與神經管內壁最薄而易成為外傷時的弱點有關。
關鍵字
無資料並列摘要
From 1986 to 1991, sixty cases of sudden blindness following head injury were included in this study. Ten cases were carefully monitored without any kind of treatment; these patients served as controls. Fifty cases received medical and/or surgical treatment. Fifty patients (the medical group) were treated with intravenous dexamethasone or oral prednisolone; twenty six patients (the surgical group) underwent optic canal decompression in addition to medical treatment, 2 by transantral, 20 by transorbital, 4 by transpterional. None of the control patients showed any improvement in visual acuity. Eighteen of the 50 cases (36%) in the medical group had visual improvement, while 13 of 26 cases (50%) in the surgical group had visual improvement. Patients with vision better than light perception immediately after the trauma benefited snore from treatment than did the patients with complete visual loss (57% vs. 21% improved in the medical group; 78% vs. 35% improved in the surgical group). Thirteen of the 60 cases (22%) had a fracture of the medial wall of the optic canal, as seen by computed tomographic scan, which was compatible to the anatomical finding, the medial wall was a weak point susceptible to traumatic injury. Such optic canal fracture was correlated wills poor visual acuity and poor prognosis.