• JiaHui Huang, XiaoSi Chen, Zixuan Wang, Shengze Deng, Jian Duan, Guohui Lu, and Dongwei Zhou.
• Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China; Jiangxi Provincial Key Laboratory on Neurosurgery, Nanchang, Jiangxi, China.
• World Neurosurg. 2020 Jun 1; 138: e564-e578.

ObjectiveTo comprehensively compare the vision improvement rate in patients with traumatic optic neuropathy with different surgical timing and other different preoperative conditions.MethodsPubMed, Embase, and MEDLINE Ovid were searched to identify studies. We performed subgroup analyses for differences in the surgical timing, surgical approach, optic canal fractures, state of consciousness after trauma, time of visual loss development, incision of the optic nerve sheath, and treatment methods.ResultsA total of 74 studies involving 6084 patients were included in the final analysis. In the groups of patients with early (≤3 days), middle (4-7 days), and late (>7 days) surgical interventions, 58.4%, 53.2%, and 45.4% demonstrated visual improvements, respectively. The results of the statistical analysis revealed that patients with early surgical intervention had a higher improvement rate than patients with late surgical intervention (P = 0.00953). The improvement rate was significantly lower for patients who presented with no light perception before surgery than for patients whose vision was better than no light perception (relative risk, 0.498; 95% confidence interval [CI], 0.443-0.561; P = 0.001) and lower for patients with immediate visual loss after trauma than for those with secondary visual loss (relative risk, 0.639; 95% CI, 0.498-0.819; P = 0.001).ConclusionsWe recommend that patients seek medical treatment as soon as possible after traumatic optic nerve injury, and patients with secondary injuries can have a good recovery effect while still living with light perception or more. The option of treatment and whether to incise the optic nerve sheath still remains controversial.Copyright © 2020 Elsevier Inc. All rights reserved.

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