Clinical Profile and Visual Outcomes after Treatment in Patients with Dysthyroid Optic Neuropathy

Abstract

PurposeTo report the clinical data and visual outcomes after treatment of patients with dysthyroid optic neuropathy (DON).MethodsWe retrospectively reviewed the medical records and orbital images of 40 patients (65 eyes) with DON and analyzed the visual outcomes after treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression.ResultsThe study included 21 men and 19 women, with 10 (25%) being diabetic patients. Visual field test results revealed defects in 88.7% of DON eyes; afferent pupillary defects in 63.2%; reduced color vision in 78.5%; and abnormal visual evoked potentials in 84%. Orbital imaging showed moderate to severe apical crowding in 95% of the orbits and intracranial fat prolapse in 24.2%. Median best corrected visual acuity improved from 0.4 to 1.0 after one year of treatment (p < 0.001). We noted more improvement in vision with the use of decompressive surgery than with non-surgical methods (p < 0.05). Recurrences occurred in 7 patients who had not received orbital radiotherapy.ConclusionsVisual field defects and apical crowding seen on orbital imaging were the most sensitive indicators for the detection of DON. Treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression effectively improved visual outcomes in cases of DON.

Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management

“…There exists a complex interplay between glycemic control and thyroid function. While the prevalence of diabetic patients with TED is similar to the normal population (0.22 – 0.26%), the prevalence of patients with insulin-dependent diabetes mellitus (IDDM) is significantly higher (1.7%), and among these patients, the disease course is generally more severe and refractory [14]. The vasculopathy associated with DM leads to marginal oxygenation of the optic nerve, leaving it more susceptible to damage due to EOM expansion and optic nerve compression.…”

Surgical Treatment of Dysthyroid Optic Neuropathy: Long-Term Visual Outcomes with Comparison of 2-Wall versus 3-Wall Orbital Decompression

“…[1][2][3] The optimum management strategy for DON is controversial. 4 Systemic corticosteroids are the treatment of choice as a first line treatment in most cases, 5 Correspondence: Safak Korkmaz, Dü zce Devlet Hastanesi, Gö z Hastalıkları Bö lü mü , Dü zce 81000, Turkey. Tel: +90 505 610 19 21.…”

Central Retinal Vein Occlusion Resolving After Orbital Decompression in Thyroid Eye Disease

“…Studies have shown improvement in proptosis (ranging from 3-8 mm in mean decrease in proptosis), 7-11 maintenance or improvement in vision, 8,11,12 and resolution of compressive optic neuropathy. 8,11,12 Although thyroid eye disease is listed as a potential risk factor for CRVO, 3,4 the authors were unable to find a single case in the literature. Resolution of CRVO after orbital decompression has not been previously reported.…”