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—Dr Seiff is concerned that the concomitant use of corticosteroids makes it difficult to attribute our good results to surgery. However, all of the patients were treated for 48 hours or less, which would make it unlikely that the corticosteroid treatment affected the recovery of visual function. We nevertheless agree that one cannot confidently credit surgery for the visual recovery, and we look forward to seeing the results of a prospective study of consecutive cases of acute indirect traumatic optic neuropathy managed solely by canal decompression.A protocol of immediate surgical decompression does mean that some patients who would improve with steroid therapy alone undergo surgery. However, to delay surgery for days waiting for some benefit from the steroids seems to compromise the chance of recovery in other patients. Furthermore, the patients who get better with steroids might have a more complete recovery with both steroids and immediate
Joseph MP, Lessell S, Rizzo J, Momose KJ. Therapy for Traumatic Optic Neuropathy-Reply. Arch Ophthalmol. 1991;109(5):610. doi:10.1001/archopht.1991.01080050016002
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