Steroids not beneficial in surgically managed traumatic optic neuropathy

This retrospective study found that steroids had no beneficial effect on visual outcome in patients with traumatic optic neuropathy who underwent optic nerve decompression surgery.

Various studies have shown no clear benefit for either a single (surgey alone) or combined (surgery and steroids) therapy regimen for traumatic optic neuropathy, and recent evidence even suggests a possible detrimental effect of steroids. 

Subjects were 42 traumatic optic neuropathy patients managed with optic nerve decompression surgery with or without steroids. Of the 21 patients who received steroids, 10 received a high-dose systemic regimen of a more than 500 mg methylprednisolone initial dose, and 11 were treated with a lower dose.

Visual improvement was seen in 38 percent of all cases. The improvement rate in patients treated with steroids was 29 percent, compared with 69 percent in those treated without steroids. 

Because the group receiving steroids had a worse initial visual acuity than the group that didn't receive steroids, the authors conducted a separate analysis of 19 cases with intermediate or good initial visual acuity. Three of eight patients in the steroid group had a good outcome, compared with eight of 11 patients in the surgery-only group. This suggests that even after correction for the observed over-representation of patients with bad initial visual function, steroids did not have a beneficial effect on the visual outcome in traumatic optic neuropathy.

The authors conclude that these results confirm a high vision recovery rate in traumatic optic neuropathy patients treated with decompression surgery. However, steroid treatment did not provide any additional benefit in visual recovery. They say that further prospective controlled trials are urgently needed to clarify the role of steroids in patients with traumatic optic neuropathy, especially considering the negative side effects described in other trials.