Visual Outcome after Systemic Steroid Therapy in Traumatic Optic Neuropathy

Author(s): Saha R, Roy P, Rahman A, Hossain MM, Zafrullah TA, Rahman AKMS.

Background: Traumatic optic neuropathy (TON) is an acute injury of the optic nerve due to trauma. It is an ocular emergency that demanding early treatment. Systemic steroids and surgical decompression are the recommended treatment. Objective: To assess the visual outcomes after systemic steroid therapy among patients with TON. Methods: This prospective observational study was conducted at Department of Neuro-ophthalmology, National Institute of Ophthalmology and Hospital (NIO&H), Dhaka, Bangladesh, from December 2019 to February 2022, on 48 eyes of 48 patients with TON. Patients were selected on selection criteria; they underwent detail ocular examination as well as relevant investigations. Methylprednisolone 1 gram was given intravenously for 5 days followed by oral prednisolone tablet 1 mg/kg body weight daily in tapering dose for 2 weeks. They were followed up on 1 week, 1 month and 3 months after starting treatment. Best corrected visual acuity (BCVA) in log MAR unit, color vision by Ishihara pseudoisochromatic chart and relative afferent pupillary defect (RAPD) grades were assessed in each follow up. Morphology of the disc was assessed prior to starting treatment and at final follow up. Results: The mean(±SD) base-line BCVA was 0.99±0.22 Log MAR unit, it was 0.89±0.30, 0.69±0.37 and 0.39±0.37 after 1 week, 1 month and 3 months respectively. The mean base-line value of color vision was 1.48±2.27, it was 8.98±3.65, 18.15±7.00 and 23.02±8.66 after 1 week, 1 month and 3 months respectively. We found a significant improvement in RAPD grading at final follow up (p <0.001). Pallor of the disc was found among 20 patients at final follow-up (<0.001). Conclusion: Visual status of patients with traumatic optic neuropathy improves by systemic steroid therapy. It is evident by significant improvement of visual acuity, color vision and RAPD grading.