Surgical outcomes and prognostic factors in traumatic optic neuropathy: a systematic review and meta-analysis of the endoscopic optic nerve decompression.

Role of Surgery Versus Medical Treatment for Traumatic Optic Nerve Compression: A Systematic Review and Meta-Analysis.

BACKGROUND Traumatic optic neuropathy (TON) can result in irreversible blindness. A consensus is not currently available on the superior treatment modality for TON. This study evaluates the literature to determine the superior treatment modality and the impact of time to treatment on outcomes. METHODS A systematic search was conducted following Preferred Reporting for Systematic Reviews and Meta-Analysis guidelines. Random effects models were used to pool relative risk from RCTs, Peto odds ratios from sparse controlled nonrandomized studies, and arcsine transformed crude rates of the outcomes from uncontrolled case series and case reports. RESULTS There were 51 studies were included in our quantitative synthesis. Low-quality evidence suggests systemic corticosteroids increase the rates of improved visual acuity when compared with observation alone in adolescents and adults (Peto OR 2.7 (1.5; 4.9); NNT 4 (2;9)). Early (< 24 hours from trauma) versus delayed (within 7 days) prednisolone administration does not result in greater rates of improved visual acuity in children (Peto OR 2.8 (0.3; 29.0)). When surgery is performed, early surgery results in greater rates of improvement in visual acuity than later surgery in adults and children (Peto OR 6.0 (1.9; 19.4) NNT 2 (5;1)). CONCLUSIONS Systemic corticosteroids were superior to observation alone, but surgical decompression did not significantly improve visual acuity when compared to systemic therapy. The results of this review suggest that medical management and surgical intervention have therapeutic value in the resolution of TON; however, in the instance of neuropathy that is refractory to medical management in the setting of injuries with deformities that warrant surgical repair, the pursuit of intervention within a week from injury may prove useful. Further contributions of high-level evidence are required to substantiate case-by-case treatment algorithms.

Clinical characteristics, management and visual outcomes of traumatic optic neuropathy: a five-year retrospective study from a tertiary referral centre.

BACKGROUND Traumatic optic neuropathy (TON) is a potentially blinding complication of craniofacial trauma with an uncertain prognosis and no established standard of care. Evidence on outcomes and prognostic factors remains limited, particularly in Southeast Asian populations. METHODS A retrospective observational study was conducted at a tertiary referral centre in Malaysia between September 2020 and August 2025. Patients diagnosed with TON were identified through medical record review. Visual acuity (VA) was categorised according to the World Health Organization (WHO) visual impairment classification. Visual outcomes at one-year follow-up were analysed using the Wilcoxon signed-rank test, and factors associated with visual improvement were evaluated using Fisher's exact test. RESULTS Fifty-eight patients were identified, of whom 54 had complete data for visual outcome analysis. The median age was 23.5 years, and most patients were male (82.8%). Road traffic accidents were the predominant aetiology, accounting for 86.2% of TON cases. TON occurred across all traumatic brain injury severities, with comparable distribution in mild and severe cases. At presentation, 53.8% had severe visual impairment, including 13.8% with no perception of light. There was a statistically significant overall improvement in visual acuity at one-year follow-up compared with baseline (p = 0.003). However, subgroup analysis showed no significant association between treatment modality and visual improvement. Visual improvement was also not significantly associated with age, baseline severity, timing of corticosteroid initiation, or the presence of orbital or skull fractures and intracranial haemorrhage (all p > 0.05). CONCLUSION Visual outcomes in TON are variable and unpredictable, highlighting the importance of early neuro-ophthalmic assessment, close visual monitoring, and appropriate counselling regarding the guarded visual prognosis. Due to the relatively small sample size of this cohort, these findings may not be generalisable to broader populations.

Radiologically measured optic nerve sheath diameter as a predictor of mortality and functional outcomes in stroke patients: A systematic review and meta-analysis

Objective: Optic nerve sheath diameter (ONSD) has emerged as a non-invasive marker of intracranial pressure and may provide prognostic information in patients with acute stroke. However, studies evaluating its association with mortality and functional outcomes have reported inconsistent findings. This systematic review and meta-analysis aimed to evaluate the prognostic value of radiologically measured ONSD in stroke patients. Methodology: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted from database inception to 10 March 2026. Observational studies evaluating ONSD measured by computed tomography or ocular ultrasonography in adult stroke patients were included. Random-effects meta-analysis was performed to pool mean differences (MD) in ONSD between outcome groups and odds ratios (OR) for mortality associated with elevated ONSD. Results: Sixteen studies were included in the review. Seven studies reported ONSD values for mortality analysis, demonstrating significantly larger ONSD in patients who died compared with survivors (MD 0.50 mm, 95% CI 0.15-0.85; I²=86%). Five studies evaluating functional outcomes showed significantly greater ONSD in patients with poor outcomes (MD 0.60 mm, 95% CI 0.26-0.93; I²≈89%). Three studies reporting risk estimates indicated that elevated ONSD was associated with a higher risk of mortality (OR 5.87, 95% CI 3.11-11.09; I²=64%). Sensitivity analyses and subgroup analyses confirmed the robustness of these findings. Conclusions: Enlarged ONSD may be associated with increased mortality and poorer functional outcomes in stroke patients. ONSD measurement may serve as a simple, non-invasive adjunct for early prognostic assessment, although further standardised prospective studies are needed.

Endoscopic Endonasal Optic Nerve Decompression for Traumatic Optic Neuropathy: A Systematic Review

Introduction Traumatic optic neuropathy (TON) is an acute injury to the optic nerve caused by direct or indirect trauma, often resulting in vision loss. Endoscopic transsphenoidal optic nerve decompression (EOND) is a minimally invasive technique designed to relieve pressure on the optic nerve. This systematic review evaluates the efficacy, safety, and visual outcomes of EOND in patients with TON. Methods A systematic search of PubMed, Scopus, and Google Scholar was conducted for articles published between 2014 and 2024. Keywords included “optic nerve decompression”, “traumatic optic neuropathy”, and “endoscopic optic nerve decompression”. After screening 42 articles, 16 studies met the inclusion criteria and were analyzed. Results All included studies used the endoscopic transsphenoidal approach. The mean visual recovery rate was 58.4%. All patients received postoperative corticosteroids. Study populations ranged from 11.7 to 68.1 years, including 24 females and 354 males. Postoperative complications were reported in 25% of studies, most commonly cerebrospinal fluid (CSF) leaks. Discussion Our findings demonstrated that endoscopic endonasal optic nerve decompression (EOND) is a safe and effective option for traumatic optic neuropathy (TON) patients unresponsive to steroids, with a mean visual recovery rate of 58.4% and a low complication profile, most commonly CSF leaks. While EOND offers clear advantages over traditional approaches, including minimal invasiveness and excellent visualization, the heterogeneity of existing data and the limited number of high-quality studies underscore the need for standardized protocols and further prospective research to optimize patient selection and surgical timing. Conclusion EOND is a safe and effective intervention for TON patients unresponsive to medical therapy, offering minimal scarring, improved visualization, and rapid recovery. However, the limited number of studies and the heterogeneity of data highlight the need for further high-quality research to optimize outcomes.

Intraocular foreign bodies: a systematic review and meta-analysis of clinical manifestations, diagnostic challenges and management strategies.

BACKGROUND/AIMS Retained intraocular foreign bodies (IOFBs) are important causes of vision-threatening ocular trauma and preventable visual impairment. This systematic review and meta-analysis evaluated the clinical manifestations, diagnostic approaches, surgical management and visual outcomes associated with IOFBs. METHODS A systematic search of PubMed, Embase, Scopus and Web of Science identified studies published between 1 January 2000 and 30 November 2025. Eligible studies reporting clinical presentation, imaging findings, management strategies or outcomes of retained IOFBs were included. Data were synthesised using a random-effects meta-analysis model. RESULTS A total of 59 studies involving 4289 patients were included of which 42 were eligible for quantitative meta-analysis. Reduced visual acuity (78%), ocular pain (42%) and intraocular inflammation (36%) were the most common clinical manifestations. Endophthalmitis occurred in 12.4% and retinal detachment in 9.8% of cases. Favourable visual outcomes (Best Corrected Visual Acuity-BCVA≥20/40) were achieved in 65.7% of patients. CT demonstrated the highest diagnostic accuracy (91.2%), while ultrasonography showed 83.6% sensitivity particularly in media opacity. Pars plana vitrectomy was the predominant surgical approach, with an overall surgical success rate of 96.5%. Early IOFB removal (≤24 hours) was associated with improved visual recovery and reduced complications. CONCLUSIONS Early diagnosis and timely surgical intervention are critical for optimising outcomes in retained IOFBs. CT and pars plana vitrectomy remain central to management, while delayed intervention increases the risk of severe complications. Standardised protocols and prospective multicentre studies are needed to strengthen evidence and improve patient care.

Pure endoscopic resection of brainstem cavernous malformations: a systematic review of current evidence and future directions