Controversies in neuro-ophthalmology: Steroid therapy for traumatic optic neuropathy.
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Date
2014-10
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Abstract
Background: There is an increase in the incidence of traumatic optic neuropathy (TON) due to increasing
urbanization and rapid spurt in the number of motor vehicles on the road. Despite early presentation
and ease of diagnosis the visual outcomes in TON are still limited. There is also significant confusion
about the timing, dose and efficacy of steroid treatment in its management. Purpose: To provide a clinical
update of the pros and cons of steroid therapy for TON. Design: The paper is a retrospective review of
the currently available literature in the English language indexed in PubMed. Methods: A PubMed search
was conducted by the authors using the following terms: Traumatic optic neuropathy, megadose, steroids,
methylprednisolone. Relevant original articles, review articles, and case reports related to the topic of
discussion were evaluated and discussed in the paper. Results: There is no prospective randomized control
trial evaluating the effect of steroids in TON. There are varying reports on the effect of steroid therapy
from significant improvement to no difference compared to observation. Conclusion: The decision to give
steroids to patients with TON has to be on an individual case to case basis and must involve informed
consent from the patient. There are documented advantages and disadvantages of steroid therapy and a
prospective, randomized, controlled trial is necessary comparing steroids, surgery and observation before
definitive management can be evolved.
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Keywords
Megadose, methylprednisolone, steroids, traumatic optic neuropathy
Citation
Saxena Rohit, Singh Digvijay, Menon Vimla. Controversies in neuro-ophthalmology: Steroid therapy for traumatic optic neuropathy. Indian Journal of Ophthalmology. 2014 Oct ; 62 (10): 1028-1030.