203 posters, 14 topics, 5 sessions, 817 authors, 256 institutions

The AAPS 102nd Annual Meeting

May 18-21, 2024 | The Westin Copley Place, Boston, MA

D14

Traumatic Optic Neuropathy - Craniofacial Fracture Patterns And Management

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Poster Presenter

Nawal Shams

Authors

Nawal Shams, Bashar Hassan, Ferris Zeitouni, Taylor Kolosky, Nicholas Randolph, Magdi Elghannam, Shannath Merbs, Paul Manson, Michael Grant

Affiliations

University of Maryland School of Medicine, Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine

Part of Topic

Craniofacial/Peds

Traumatic Optic Neuropathy – Craniofacial Fracture Patterns And Management

Nawal Shams,1 Bashar Hassan, MD,2,3 Ferris Zeitouni,3 Taylor Kolosky,1 Nicholas Randolph,1Magdi Elghannam,1 Shannath L. Merbs, MD, PhD,4 Paul N. Manson, MD,3 Michael P. Grant, MD, PhD2

1. University of Maryland School of Medicine, Baltimore, Maryland, USA, 2. Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA,3. Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, 4. Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA

Introduction

vUp to half of patients with traumatic optic neuropathy (TON) develop permanent vision loss.

vThe diagnosis and management of TON are challenging.

vPurpose: To identifycraniofacial fractures associated with TON and investigate the efficacy of steroid therapy in TON treatment.

Methods

vRetrospective cohort from 2018-2022 to determine craniofacial fractures associated with TON

vRetrospective cohort from2013-2022 to compare steroid therapy to oberservation

vTrauma patients with OFR at:

•R Adams Cowley Shock Trauma Center

vPrimary outcome: visual acuity improvement andtime to improvement.

vMultivariate logistic and linear regressions were performed

Results

Craniofacial Fracture Patterns

v2374 patients presented with acute faacial fractures between 2018-2022

v21 had TON (0.9%)

vSphenoid sinus fractures were associated with the greatest odds of TON (aOR [95% CI] 25 [9-68]) followed by LeFort III and naso-orbitoethmoid (NOE) fractures (aOR [95% CI] 13 [4-42] and 7 [2-24], respectively)

TON Management

vBetween 2013 and 2022, treatment outcomes were analyzed in 86 TON patients (96 eyes).

v Median (IQR) follow up was 9 (4-31) months

vSteroid therapy consisted of IV methylprednisolone ranging from 250-1000mg for 3 days max

vmore likely to have improvement in visual acuity with steroid therapy compared to those managed with observation (8/13 [62%], 27/83 [33%] , P<0.05)

vsteroids were associated with 6 times the odds of visual acuity improvement (aOR [95% CI] 5.54 [1.15-26.71], P=0.033)

v57-day quicker visual acuity improvement compared to observation (B=-57.1, P=0.007)

Conclusion

vPatients with sphenoid sinus fractures should be evaluated for TON to initiate therapy early

Steroid therapy results in a more rapid improvement and better final visual acuity in management of TON