Isolated-check visual evoked potential: a more sensitive tool to detect traumatic optic neuropathy after orbital fractur
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Isolated-check visual evoked potential: a more sensitive tool to detect traumatic optic neuropathy after orbital fracture Yanjie Tian 1 & Yinhao Wang 1 & Ziyuan Liu 1 & Xuemin Li 1 Received: 31 January 2020 / Revised: 29 July 2020 / Accepted: 11 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To establish a more sensitive diagnostic tool for traumatic optic neuropathy (TON), we explored the diagnostic efficacy of isolated-check visual evoked potential (ic-VEP) for TON in orbital fracture and compared ic-VEP with pattern-reversal visual evoked potential (P-VEP) testing. Methods This was a prospective single-center study. A total of 137 eyes from 131 patients diagnosed between December 2016 and October 2019 with orbital fractures were included in the study. Injury history, best-corrected visual acuity (BCVA), visual field, computed tomography (CT), P-VEP, and ic-VEP data were collected. Parameters of ic-VEP (signal-to-noise ratio [SNR]) and P-VEP (peak latency and amplitude of P100) were compared and diagnostic accuracy was analyzed. Results TON was associated with worse BCVA than non-TON (median 0.52 versus 0.10 logMAR, P < 0.001). SNRs were negatively associated with the P100 peak latency while positively associated with the P100 amplitude. The sensitivity of ic-VEP for TON (79.6%) was higher than that of P-VEP (61.2%, P = 0.049), although this difference was not statistically significant after Bonferroni correction. Using ic-VEP and P-VEP together could increase sensitivity (87.8%). Maximum areas under curve were obtained using the SNR criteria of 1.3, 1.47, and 1.54 at 8%, 16%, and 32% depth of modulation, respectively. Conclusion ic-VEP was more sensitive than P-VEP in diagnosing TON, and a combination of the two examination tests was recommended. The use of ic-VEP as the new diagnostic standard technique for TON should be considered. Keywords Traumatic optic neuropathy . Orbital fracture . Visual evoked potential . Diagnostic efficacy
Introduction Orbital fracture is common in facial fracture patients [1, 2]. Extracranial neurologic complications after mid-face fractures occur in approximately 50% of all trauma cases [3]. Optic nerve injury is the third most common cranial nerve trauma, and traumatic optic neuropathy (TON) is one of the leading causes of blindness following ocular trauma. Yanjie Tian and Yinhao Wang contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00417-020-04895-2) contains supplementary material, which is available to authorized users. * Xuemin Li [email protected] 1
Department of Ophthalmology, Peking University Third Hospital, No. 49, Garden North Road, Haidian District, Beijing, China
TON can be induced by direct or indirect trauma, including extrinsic compression (retrobulbar hemorrhage, edema, or emphysema), contusion, torsion, and strain and shear stresses [4–6]. Traumatic factors associated with TON can induce retinal ganglion cell (RGC) death and axon d
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