Minimally Invasive Sutureless, Transcaruncular, Transorbital Approach for Optic Canal Decompression for Traumatic Optic Neuropathy: Visual Results

Abstract Traumatic optic neuropathy is a devastating condition characterised by a loss of vision following trauma. The present study was designed to evaluate the visual results after surgical decompression of the optic nerve using a minimally invasive trans-caruncular trans-orbital approach. A retrospective study was designed to study the visual improvement in patients with traumatic optic neuropathy who underwent optic canal decompression by the trans-caruncular/transorbital route. Twenty five patients who presented with reduced vision following trauma and no improvement despite conservative management were included in the study. Patients with life threatening conditions, as well as those who did not have a record of visual assessment at presentation were excluded from the study. Patients with optic atrophy at presentation were also excluded. All patients underwent the surgical decompression under local anaesthesia. Visual function was assessed before and at 2 weekly intervals after surgery. The mean age of the patients in the study was 30 ± 7.83 years with 21 males (84%) and 4 females (16%). The mean preoperative vision was 3.02 ± 1.81 LOGMAR. 13 patients (52%) had no perception of light at presentation. The mean postoperative vision was 0.58 ± 0.53 (range of 0.2-2 LOGMAR). The mean percentage improvement was 65.06 ± 27.69%. Three patients (23%), with no perception of light at presentation, had no improvement in vision. The minimally invasive trans-caruncular, trans-orbital approach to the decompression of the optic nerve in traumatic optic neuropathy is a useful technique with good visual results. This may be performed with under local anaesthesia with rapid postoperative rehabilitation.