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Outcome of the surgical decompression for traumatic optic neuropathy: a systematic review and meta-analysis

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Abstract

There exists a persisting controversy regarding the indications for optic nerve surgical decompression (ONSD) in traumatic optic neuropathy (TON). A meta-analysis is warranted to help guiding therapeutic decisions and address gaps in knowledge. The authors conducted a search of PubMed and MEDLINE electronic databases. Primary endpoint was the improvement in the visual function with ONSD in comparison with the conservative management. Secondary endpoint was visual function improvement when surgery was performed within the first 7 days. A random effects model meta-analysis was conducted. Data from each study were used to generate log odds ratio and 95% confidence intervals, to compare post-operative visual improvement. Nine studies met the inclusion criteria for analysis, comprising 766 patients. Visual improvement occurred in 55% (198/360) of patients treated with ONSD, and in 40% (164/406) of those who underwent conservative treatment. Forest plot revealed significant differences in the visual function improvement among these two groups, although further analysis revealed the studies were heterogeneous (log OR, 0.81; CI, 0.07–1.55; I2, 62.8% p = 0.015). Overall, patients who underwent early surgery had better visual outcomes (log OR, 0.94; CI, 0.29–1.60; I2, 0% p = 0.9). ONSD is an effective technique to improve the outcome in the visual function in patients with TON. A lack of randomized controlled trial—and inherent surgical selection and publication bias—limits direct comparison between surgical decompression and conservative management. Suitably designed prospective cohort studies may be useful in identifying patients more likely to receive benefit from ONSD.

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Authors and Affiliations

  1. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W. 10th Ave., N-1049 Doan Hall, Columbus, OH, 43210, USA

    Rafael Martinez-Perez, Thiago Albonette-Felicio, Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

  2. Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

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  1. Rafael Martinez-Perez
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  2. Thiago Albonette-Felicio
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  3. Douglas A. Hardesty
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Correspondence to Daniel M. Prevedello.

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Conflict of interest

Daniel M. Prevedello is a consultant for Stryker Corporation and Medtronic Corp. Daniel Prevedello has equity on 3 rivers LLC, eLUM Technologies, LLC, and Soliton LLC. Daniel Prevedello receives royalties from KLS-Martin and Mizuho. Ricardo L. Carrau is a consultant for Medtronic Corp.

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Informed consent and ethical approval were not deemed necessary by the local ethics in view of the design of the study (review). Informed consent was not deemed necessary by the local ethics in view of the design of the study.

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Electronic supplementary material

Supplementary table 1.

Newcastle – Ottawa Quality Assessment Scale of the studies included in the metanalysis (DOCX 13 kb)

Supplementary table 2.

Risk of bias assesment with the Robins-I tool for non-randomized studies (DOCX 17 kb)

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Martinez-Perez, R., Albonette-Felicio, T., Hardesty, D.A. et al. Outcome of the surgical decompression for traumatic optic neuropathy: a systematic review and meta-analysis. Neurosurg Rev 44, 633–641 (2021). https://doi.org/10.1007/s10143-020-01260-z

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