Optic nerve sheath decompression for traumatic optic neuropathy: a case report

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43 year old Liu, a car accident in July 2, 2012, right frontal impact after the coma, woke up and found that the right eye is completely bli

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43 year old Liu, a car accident in July 2, 2012, right frontal impact after the coma, woke up and found that the right eye is completely blind; immediately to the Sichuan Provincial People's Hospital emergency department visits, emergency examination of the right eye: no light perception, mydriasis, direct light reflex, cranial CT showed that the fracture of the skull base.

Duty doctor will report the case to Chen Hui, deputy director of the physician immediately after the income of Sichuan Provincial People's Hospital ophthalmology. After 2 days of treatment with high doses of hormones, mannitol dehydration, edema relief, and neurotrophic support, the patient's visual acuity remained unchanged. Chen Hui, deputy director of physicians and patients and their families to discuss in detail its condition, experience of previous treatment, and compared the drug conservative treatment, optic nerve decompression, optic nerve sheath incision decompression of three kinds of treatment indications, surgical procedure, possible complications, advantages and disadvantages; clearly inform patients and their families through the optic nerve sheath incision decompression is possible for patients to bring light; and inform patients of earlier surgery, the greater the possibility of recovery of visual acuity.

After a detailed discussion with patients and their families for 2 hours, the patient and his family fully understand Chen Hui's deputy director of surgical treatment program, requiring surgery as soon as possible.

July 4th, under the microscope, Chen Hui, deputy director of physicians for patients with smooth operation. Postoperative recovery of patients, safe return to ward. First days after operation in patients with visual acuity of the right eye can see the light; third days after operation in patients with right eye can see through the characters; fifth days after surgery in patients with all round vision which you can see the doctor as the standard, the pupillary light reflex has been restored; in July 13th, patients with visual acuity reached 0.1, discharge.

Incision and decompression of optic nerve is a kind of operation that directly through the orbit, exposing the optic nerve intraorbital segment, cutting the optic nerve sheath in the inner segment of the orbit, so as to reduce the intracranial pressure. The operation is much less risky than the optic canal decompression. The intracranial surgery is mainly used in foreign UHV (Idiopathic Intracranial Hypertension, IIH) caused by the decrease of visual acuity, visual field defect, also for intractable intracranial hypertension oppression of any cause of optic neuropathy (such as cryptococcal meningitis type), optic nerve trauma and subarachnoid hemorrhage patients, new the study shows that it may have on non ischemic optic neuropathy patients help.

Chen Hui, deputy director of physicians in the United States Dean A McGee Institute of Ophthalmology, a comprehensive study of the nerve Ophthalmology, completely mastered the change of surgical technology, research and development of new surgical instruments, so that the operation procedure is more simple.

2012-8-14 update:

In the past February, more of these patients have been treated effectively. At present, a total of 5 cases of traumatic optic neuropathy patients with partial recovery of vision.

Chen

 

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