Background Traumatic optic neuropathy (TON) is a severe cause of vision loss after craniofacial trauma, occurring in up to 5% of maxillofacial injuries. Despite extensive investigation, optimal management remains controversial. Optic canal decompression (OCD), particularly via a trans-nasal endoscopic approach, has regained attention; however, prognostic factors for visual recovery remain unclear. This systematic review and meta-analysis aimed to identify predictors of visual outcome following OCD for TON. Methods Following PRISMA guidelines, a systematic PubMed search identified studies reporting visual outcomes after OCD for TON. Eligible studies included preoperative and postoperative visual acuity (VA), surgical approach, timing of surgery, and optic canal fracture status. Data were independently extracted by two reviewers, and study quality was assessed using the Joanna Briggs Institute checklist. Results Seven studies comprising 39 patients (41 optic canals), including two institutional cases, were included. The mean age was 38.3 years, and 77.4% were male. OCD was performed via trans-nasal (73.1%), trans-cranial (24.4%), or trans-orbital (2.4%) approaches. Optic canal fractures were present in 36.6%, and early surgery (<72 h) was performed in 63.4%. Visual improvement occurred in 73.2% of cases. Logistic regression identified absence of optic canal fracture and better preoperative VA as independent predictors of visual recovery. Conclusion OCD is most effective in patients with indirect TON who retain residual vision without optic canal fracture. Direct TON associated with fracture likely reflects irreversible neural injury. These findings support early trans-nasal OCD as a less invasive option in carefully selected patients.
Okano et al. (2026) studied this question.