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Wydanie 4/2011
str. 149

Wygaszone wzrokowe potencjały wywołane (VEP) w przebiegu pourazowej neuropatii nerwu wzrokowego po endoskopowej dekompresji

Extinguished VEP in the Course of Traumatic Optic Neuropathy after Endoscopic Decompression

Przemysław Pawłowski^1,2, Nina Skowrońska², Łukasz Lisowski³, Tomasz Łysoń⁴, Andrzej Sieśkiewicz⁵, Alina Bakunowicz-Łazarczyk¹

¹ Pracownia Elektrofizjologii Narządu Wzroku Kliniki Okulistyki Dziecięcej z Ośrodkiem Leczenia Zeza
  Uniwersytetu Medycznego w Białymstoku
  Kierownik: prof. dr hab. n. med. Alina Bakunowicz-Łazarczyk
² Oddział Chorób Oczu Wojewódzkiego Szpitala Zespolonego w Białymstoku
  Kierownik: dr n med. Roman Malesiński
³ Koło Naukowe Elektrofizjologii Narządu Wzroku Kliniki Okulistyki Dziecięcej Uniwersytetu Medycznego w Białymstoku
  Opiekun Koła: dr n med. Przemysław Pawłowski
⁴ Klinika Neurochirurgii Uniwersytetu Medycznego w Białymstoku
  Kierownik: prof. dr hab. n. med. Zenon Mariak

Summary: Purpose: The purpose of the study was a long-term evaluation of the optic nerve function after endoscopic decompression due to the traumatic neuropathy.
Patient and Methods: 43-year old male was referred to the Department of Ophthalmology due to visual acuity deterioration 3 weeks after the right eye blunt trauma. The loss of vision was observed by patient 1 week after trauma. The primary ophthalmological examination revealed the papilloedema in the right eye. The patient was treated with 500 mg methylprednisolon pulses for 3 days followed by oral steroids. Finally endoscopic optic nerve decompression was undertaken to preserve the optic nerve function.
Results: On the primary ophthalmological examination the BCVA was Vod = 5/12, and Vos = 5/5. The papilloedema was detected in the right eye. In the PVEP test P100 amplitude was slightly reduced (4.4 µV). 1 month after the optic nerve decompression the BCVA was constant and the P100 amplitude increased to 7.7 µV. The 18-months follow-up examination revealed the significantly reduced BCVA (0.03). In addition we detected the extinguished flash VEP response in the injured eye.
Conclusions: Despite of temporary improvement of the optic nerve function in the PVEP shortly after endoscopic optic nerve decompression the late follow-up results indicate a severe optic nerve dysfunction. Unfavorable prognosis for better visual acuity in the course of traumatic optic neuropathy might be due to delayed patient submission to the Department of Ophthalmology.

Słowa kluczowe: TON, VEP, endoskopowa dekompresja nerwu wzrokowego, steroidoterapia w TON, RAPD – relatywny aferentny defekt źreniczny.

Keywords: TON, VEP, endoscopic optic nerve decompression, steroids for traumatic optic neuropathy, RAPD – relative afferent pupillary defect.

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