외상시신경병증의 임상양상과 예후
Clinical Manifestations and Prognosis of Patient with Traumatic Optic Neuropathy
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
목적: 외상시신경병증의 원인, 동반손상 등의 임상양상과 치료방법 및 예후 등을 알아보고자 하였다. 대상과 방법: 2008년 4월부터 2016년 2월까지 외상시신경병증으로 진단 받은 환자 55명을 대상으로 외상원인, 시력저하 정도, 시야결손형태, 치료방법 및 시력예후 등을 의무기록을 통하여 분석하였다. 또한 두개안면부 영상검사를 시행 받은 환자들을 대상으로 두개내출혈유무, 두개안면부골절유무 등을 분석하였고, 출혈유무, 골절부위에 따른 시력저하 정도를 비교하여 보았다. 시력손상 후 감각사시의 발생 여부도 알아보았다. 결과: 전체 외상시신경병증 환자 55명 57안의 외상원인은 교통사고가 가장 많았다. 시력저하 정도는 0.1 미만의 심한 시력저하를 보이는 환자가 60% 이상이었고, 이는 최종 경과관찰 때까지 지속되었다. 시야결손은 하측반맹 등의 수평시야결손이 많았고 주변부 위축, 중심암점 등의 형태로 나타났다. 두개내출혈은 환자의 52.4%에서 동반되었고 두개안면부골절은 90.5%로 대부분 환자에서 동반되었다. 또한 두개안면부골절환자가 안와후부골절을 동반하면 초기시력이 좋지 않았다. 고용량스테로이드 정맥주사 등의 치료는 시력예후에 영향을 주지 않았다. 감각사시는 초기시력이 좋지 않고(p=0.007), 나이가 어린 경우에 잘 발생하였다(p<0.001). 결론: 국내 외상시신경병증은 초시시력저하가 심했고 시력예후도 좋지 않았다. 또한 고용량스테로이드 정맥주사 등의 치료는 시력개선에 영향을 주지 않았다.
Abstract
Purpose: To investigate the clinical manifestations, management, ophthalmologic complications, and prognosis of traumatic optic neuropathy. Methods: A retrospective survey of 55 patients who visited Chosun Hospital from April 2009 to February 2016 was performed. The sex, age, causes, fracture characteristics, neurologic injury, and combined craniofacial bone fractures of patients who were diagnosed with traumatic optic neuropathy were statistically analyzed. Also, we investigated the rate of visual impairment in the patients with intracranial hemorrhaging and craniofacial fracture on radiologic examination and development of sensory strabismus. Results: Traffic accidents were the most common cause of traumatic optic neuropathy. Among the patients, more than 60% showed severe visual impairment of less than 0.1 that lasted until the final observation. Altitudinal visual defects were the most common visual field defect and presented as marginal atrophy and central scotoma. While intracranial hemorrhaging was showed in 52.4% of the patients, craniofacial fracture was observed in 90.5% of the patients. The initial visual acuity was decreased when the patient presented with orbital fracture located in the retrobulbar area. Intravenous high-dose steroid injection did not affect visual prognosis. Sensory strabismus occurred more commonly under conditions of poor initial vision (p = 0.007) or young age (p < 0.001). Conclusions: Traumatic optic neuropathy in Korea has a high rate of initial visual impairment with poor prognosis of vision. In addition, high-dose intravenous steroid injection did not result in visual improvement.
참고문헌 (31)
- Burch FE, "Ocular evidence of head trauma", Wisc Med J, 41, pp.1092~1097 (1942)
- Crompton MR, "Visual lesions in closed head injury", Brain, 93, pp.785~792 (1970)
- Seo JS., "Clinical evaluation of the traumatic optic neuropathy", J Korean Ophthalmol Soc, 36, pp.1790~1797 (1995)
- Park JW., "Clinical evaluation of the traumatic optic neuropathy", J Korean Ophthalmol Soc, 40, pp.3497~3505 (1999)
- Steinsapir KD., "Traumatic optic neuropathy", Surv Ophthalmol, 38, pp.487~518 (1994)
- Sabates NR., "Neuro-ophthalmological findings in closed head trauma", J Clin Neuroophthalmol, 11, pp.273~277 (1991)
- Thurman DJ., "Surveillance of traumatic brain injuries in Utah", West J Med, 165, pp.192~196 (1996)
- Pirouzmand F, "Epidemiological trends of traumatic optic nerve injuries in the largest Canadian adult trauma center", J Craniofac Surg, 23, pp.516~520 (2012)
- Edmund J., "Unilateral optic atrophy following head injury", Acta Ophthalmol(Copenh), 41, pp.693~697 (1963)
- Levin LA., "The treatment of traumatic optic neuropathy : the international optic nerve trauma study", Ophthalmology, 106, pp.1268~1277 (1999)
- Lessell S, "Indirect optic nerve trauma", Arch Ophthalmol, 107, pp.382~386 (1989)
- Chou PI., "Clinical experiences in the management of traumatic optic neuropathy", Neuro-ophthalmology, 16, pp.325~336 (1996)
- Suchoff IB., "The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury : a retrospective analysis", Optometry, 79, pp.259~265 (2008)
- Warner N., "Traumatic optic neuropathy : a review of the current literature", Curr Opin Ophthalmol, 21, pp.459~462 (2010)
- Sarkies N, "Traumatic optic neuropathy", Eye(Lond), 18, pp.1122~1125 (2004)
- Dratviman-Storobinsky O., "Progressive damage along the optic nerve following induction of crush injury or rodent anterior ischemic optic neuropathy in transgenic mice", Mol Vis, 14, pp.2171~2179 (2008)
- Agrawal R., "Controversies in ocular trauma classification and management : review", Int Ophthalmol, 33, pp.435~445 (2013)
- Ong HS., "Classification of orbital fractures using the AO", ASIF system in a population surveillance cohort of traumatic optic neuropathy, 2014, pp.33, 256~262
- Al-Qurainy IA., "The characteristics of midfacial fractures and the association with ocular injury : a prospective study", Br J Oral Maxillofac Surg, 29, pp.291~301 (1991)
- Steinsapir KD., "Traumatic optic neuropathy : a critical update", Compr Ophthalmol Update, 6, pp.11~21 (2005)
- 정지성, "외상성 3, 4, 6번 단독뇌신경마비의 동반손상과 예후", 대한안과학회지, 55(4), pp.596~601 (2014), 대한안과학회
- Young W., "The Second National Acute Spinal Cord Injury Study", J Neurotrauma, 9(Suppl 1), pp.S397~S405 (1992)
- Edwards P., "Final results of MRC CRASH, a randomized placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes as 6 months", Lancet, 365, pp.1957~1959 (2005)
- Braughler JM., "Evaluation of an intensive methylprednisolone sodium succinate dosing regimen in experimental spinal cord injury", J Neurosurg, 67, pp.102~105 (1987)
- Rajiniganth MG., "Traumatic optic neuropathy : visual outcome following combined therapy protocol", Arch Otolaryngol Head Neck Surg, 129, pp.1203~1206 (2003)
- Ropposch T., "The effect of steroids in combination with optic nerve decompression surgery in traumatic optic neuropathy", Laryngoscope, 123, pp.1082~1086 (2013)
- Wang BH., "Traumatic optic neuropathy : a review of 61 patients", Plast Reconstr Surg, 107, pp.1655~1664 (2001)
- Carta A., "Visual prognosis after indirect traumatic optic neuropathy", J Neurol Neurosurg Psychiatry, 74, pp.246~248 (2003)
- Havertape SA., "Sensory strabismus--eso or exo?", J Pediatr Ophthalmol Strabismus, 38, pp.327~330 (2001)
- Sidikaro Y., "Observation in sensory heterotropia", J Pediatr Ophthalmol Starabismus, 19, pp.12~19 (1982)
- 김규섭, "감각사시에 대한 임상적 고찰", 대한안과학회지, 46(2), pp.16~16 (2005), 대한안과학회