![obscure 2 mega obscure 2 mega](https://www.mypokecard.com/my/galery/zZCDpT6j3gh.jpg)
The benefit of surgical decompression for traumatic optic neuropathy remains obscure, 2, 9 partly because visual outcome greatly varies depending on surgeon's experience and technique level. Patients with traumatic optic neuropathy may choose to receive steroids, surgical decompression, or clinical observation. The current strategy to manage patients with traumatic optic neuropathy is suggested as follows.
![obscure 2 mega obscure 2 mega](https://ic-cdn.flipboard.com/golf.com/b777df8d28b3683ddb4dceaa5c0bf7628c7958f9/_medium.jpeg)
Dr Volpe and Dr Levin 12 presented an in-depth discussion of this specific issue in the Journal of Neuro-Ophthalmology in 2011. With no obvious advantage from any treatments, 1, 2, 9, 10, 11, 12 clinical doctors may choose their favorable way of management.
#Obscure 2 mega how to
How to manage traumatic optic neuropathy? There was no significant difference in visual outcome between patients who received steroid treatment and those who did not.
![obscure 2 mega obscure 2 mega](https://pcweenies.com/wp-content/uploads/2010/09/2008-05-09_pcw.jpg)
6 In this small trial, Dr Entezari et al 7 examined the effect of high-dose steroid (250 mg/6 h for 3 days, and oral steroid 1 mg/kg/d for 14 days) in 31 patients with traumatic optic neuropathy.
#Obscure 2 mega trial
Only one small-scale, randomized, prospective clinical trial was found in the Cochrane report by Drs Patrick Yu-Wai-Man and Griffiths. With all these limitations, to-date there is no large-scale, randomized, double-blind, prospective clinical trial for traumatic optic neuropathy. In addition, visual impairment may vary widely following an optic nerve injury. It is difficult to assess visual function at the initial stage in traumatic optic neuropathy, and only approximate results are available most of the time. Besides, the clinical condition is complex as some patients may suffer from concurrent craniofacial injury or conscious disturbance. It is difficult to recruit a large number of patients with traumatic optic neuropathy in a short period. Thus, the applicability of NASCIS II results to clinical management of traumatic optic neuropathy remains uncertain.ģ.2. 3 Most patients with traumatic optic neuropathy came for eye care later than 8 hours, because some patients may have concurrent craniofacial injury or even conscious disturbance at the initial stage. Patients who received treatment after 8 hours may have a worse outcome than the control group. In addition, the beneficial effect of megadose steroid is limited to patients receiving treatment within 8 hours. Thus, extrapolating the successful outcome of NASCIS II to the treatment of traumatic optic neuropathy is not without concern. They are different functionally and anatomically. By contrast, the spinal cord has gray matter and white matter and it includes motor neurons, interneurons, glia, and motor and sensory axons. The optic nerve is mainly composed of axons from retinal ganglion cells intermixed with glia, vessels, and connective tissues. When administered in megadoses, steroids are proposed to have an additional neuroprotective effect through the mechanism of reducing oxidative stress and decreasing reactive oxygen species.Īlthough administration of steroids in megadoses has been proved to have a neuroprotective effect on the acute spinal cord injury, it remains uncertain whether it has the same effect in optic nerve injury. 4 Traditional use of steroids (high dose, 1000 mg/d for 3 days) may reduce edema and anti-inflammation. In the next trial (i.e., NASCIS III), the authors reported an even better outcome of motor function if the treatment lasts for 48 hours instead of 24 hours. 3 The NASCIS II was a multicenter, randomized, double-blind, prospective clinical trial conducted in 1990, and its results showed that patients receiving a megadose of steroid (initial dose, 30 mg/kg, then 5.4 mg/kg/h for 23 hours) within 8 hours of spinal injury may have better neurological functions and less residual sequelae. As Dr Patrick Yu-Wai-Man 1 mentions in his review article, the use of steroid has become a popular choice for the treatment of traumatic optic neuropathy after the 1980s because of the successful use of steroids in the second National Acute Spinal Cord Injury Study (NASCIS II).