There exists a persisting controversy regarding the indications for optic nerve surgical decompression (ONSD) in traumatic optic neuropathy (TON). A meta-analysis is warranted to help guiding therapeutic decisions and address gaps in knowledge. The authors conducted a search of PubMed and MEDLINE electronic databases. Primary endpoint was the improvement in the visual function with ONSD in comparison with the conservative management. Secondary endpoint was visual function improvement when surgery was performed within the first 7 days. A random effects model meta-analysis was conducted. Data from each study were used to generate log odds ratio and 95% confidence intervals, to compare post-operative visual improvement. Nine studies met the inclusion criteria for analysis, comprising 766 patients. Visual improvement occurred in 55% (198/360) of patients treated with ONSD, and in 40% (164/406) of those who underwent conservative treatment. Forest plot revealed significant differences in the visual function improvement among these two groups, although further analysis revealed the studies were heterogeneous (log OR, 0.81; CI, 0.07–1.55; I², 62.8% p = 0.015). Overall, patients who underwent early surgery had better visual outcomes (log OR, 0.94; CI, 0.29–1.60; I², 0% p = 0.9). ONSD is an effective technique to improve the outcome in the visual function in patients with TON. A lack of randomized controlled trial—and inherent surgical selection and publication bias—limits direct comparison between surgical decompression and conservative management. Suitably designed prospective cohort studies may be useful in identifying patients more likely to receive benefit from ONSD.

关于外伤性视神经病变（TON）中的视神经外科减压（ONSD）的适应症存在持续存在的争议。进行荟萃分析有助于指导治疗决策和解决知识空白。作者对PubMed和MEDLINE电子数据库进行了搜索。主要终点是与保守治疗相比，ONSD的视觉功能有所改善。次要终点是在头7天内进行手术时视觉功能的改善。进行了随机效应模型荟萃分析。每个研究的数据用于产生对数比值比和95％的置信区间，以比较术后视觉改善。九项研究符合纳入标准，包括766名患者。在接受ONSD治疗的患者中，有55％（198/360）的患者和接受保守治疗的患者中有40％（164/406）的患者出现了视力改善。森林图显示了两组之间在视觉功能改善上的显着差异，尽管进一步的分析显示研究是异类的（log OR，0.81； CI，0.07-1.55；我²，62.8％p  = 0.015）。总体而言，谁接受早期手术的患者有更好的视觉效果（日志或，0.94; CI，0.29-1.60;我²，0％p  = 0.9）。ONSD是一种有效的技术，可改善TON患者的视觉功能。缺乏随机对照试验以及固有的手术选择和出版偏倚，限制了手术减压和保守治疗之间的直接比较。适当设计的前瞻性队列研究可能有助于确定更可能从ONSD获益的患者。