Objective　To systematically evaluate the efficacy of optic nerve decompression (OND) in the treatment of traumatic optic neuropathy (TON). Methods　A computer search was conducted for the retrospective studies on OND in the treatment of TON in PubMed, EMbase, The Cochrane Library and Web of Science from database establishment to February 7, 2023.

The obtained studies were independently screened and extracted by two researchers according to inclusion and exclusion criteria,

and their quality was assessed using the Newcastle-Ottawa Scale (NOS). The postoperative outcomes were considered to indicate

the efficiency of OND for TON. Interval estimates were expressed using a 95% confidence interval (CI), and the meta-analysis of

the collected data was performed using Stata 16.0 software. Results　A total of 42 studies, including 3,579 patients, were finally

included. The results of the meta-analysis were as follows: The overall efficiency of OND for TON was 54.2% (95% CI 49.2%-

59.2%). Subgroup analysis with different surgical approaches showed that the efficiency of endoscopic transorbital, transnasal,

and transcranial approaches for TON was 56.0% (95% CI 46.2%-65.7%), 52.8% (95% CI 45.1%-60.5%), and 50.0% (95%CI 36.1%-63.9%), respectively. The efficiency of OND ≤ 7 and >7 days post-injury was 69.5% (95% CI 55.0%-82.5%) and28.6% (95% CI 21.4%-36.2%), respectively, whereas 1-2 and 3-7 days post-injury, it was 71.5% (95% CI 45.2%-92.3%)and 51.2% (95% CI 65.3%-100.0%), respectively. The OND efficiency with and without light perception was 79.2% (95% CI 84.6%-100.0%) and 36.3% (95% CI 30.2%-42.6%), respectively. The overall efficiency of optic nerve sheath incision alongwith optic canal decompression was 40.7% (95% CI 27.0%-55.1%). Conclusion　OND is an effective method to improve vision in patients with TON. The difference in preoperative characteristics was not significant among different surgical methods. The transorbital approach showed the most favorable postoperative outcomes. The time of surgery should be as early as possible, and patients with preoperative light perception have a better prognosis. Also, intraoperative dissection of the optic nerve sheath may be helpful in vision restoration.

　Optic nerve decompression, 　Traumatic optic neuropathy, 　Transcranial access optic nerve decompression, 　

Endoscopic transnasal optic nerve decompression, 　Intraorbital pterygoid septal sinus optic nerve decompression