Compression and Stretching in Graves Orbitopathy

Cascone, Piero; Rinna, Claudio; Reale, G; Calvani, Francesco; Iannetti, Giorgio

doi:10.1097/scs.0b013e31825e3acf

Cited by 29 publications

(6 citation statements)

References 13 publications

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“…e Alhambra Expósito team also found that there was also partial relief of proptosis and upper eyelid retraction in the fellow eyes treated with MPT, but the effects were not as significant as in eyes treated with orbital decompression [28]. e possible reason may be that the removal of part of the orbital wall enlarges the orbital cavity and removes part of the adipose tissue, alleviating the pressure on the anterior orbital of muscles and soft tissues [29].…”

Section: Discussionmentioning

confidence: 99%

The Therapeutic Effect of Combination of Orbital Decompression Surgery and Methylprednisolone Pulse Therapy on Patients with Bilateral Dysthyroid Optic Neuropathy

Guo

et al. 2020

Journal of Ophthalmology

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Purpose. To investigate the synergic effect of combination of orbital decompression surgery and methylprednisolone pulse therapy (MPT) and MPT alone on the visual function in patients with bilateral dysthyroid optic neuropathy (DON). Methods. For each involved patient with bilateral DON, only one eye was treated with orbital decompression surgery which was conducted by the same doctor, and each of them received MPT after surgery. If the visual function deteriorated despite treatment, patients would switch to the other treatment. All the patients were followed up for 3 months after surgery. Clinical features of patients including best corrected visual acuity (BCVA), intraocular pressure (IOP), proptosis, upper eyelid retraction, and clinical activity score (CAS) before and after surgery were analyzed, respectively. Visual field and visual evoked potential (VEP) tests were also performed. Paired t-test and Wilcoxon matched-pairs signed ranks sum test were used to analyze the data. Result. A prospective cohort of 23 patients with bilateral DON was enrolled in this cohort study. No patients failed to the therapy or switched to another treatment. The quantitative variables were shown as means and standard deviations (SD). After 3 months of combined treatment of orbital decompression surgery and MPT, BCVA (logMAR) improved, proptosis was reduced and the upper eyelid retraction was relieved in both eyes of patients; however, these improvements were more significant in the operated eyes than in the fellow (nonoperated) eyes. IOP decreased significantly in the operated eyes (P=0.002), while having no significant change in the nonoperated eyes (P=0.993). CAS reduced by 0.8 ± 1.37 in the operated eyes and by 0.9 ± 1.28 in the nonoperated eyes (P=0.011, P=0.005, respectively), but its reduction extent showed no significant difference between the operated and fellow eyes (P=0.771). Visual field tests showed the mean deviation (MD) of the operated and fellow eyes both increased significantly after 3 months of treatment (P<0.001, P=0.001, respectively). MD of the operated eyes increased by 8.1 ± 7.72 dB, which was more significant than that of the fellow eyes which increased by 3.4 ± 5.02 dB (P=0.005). The VEP test showed that, in the operated eyes, the latency of each spatial frequency of P100 was significantly shortened (P<0.05, respectively), and the amplitude was significantly improved (P<0.05, respectively); however, there was no significant change in VEP parameters of the fellow eyes (P>0.05, respectively). The latency in the operated eyes improved by 28.1 ± 29.93 ms in 60′ P100, by 40.2 ± 32.87 ms in 30′ P100, and by 20.7 ± 25.87 ms in 15′ P100 respectively, which was more excellent in the degree of the improvement than that in the fellow eyes (P=0.002, P=0.001, P=0.005, respectively). Conclusion. A combination of orbital decompression and MPT can significantly improve visual function in patients with DON, reduce intraocular pressure, and relieve clinical symptoms such as upper eyelid retraction and proptosis, while MPT alone has a limited effect. For DON patients, orbital decompression should be performed promptly to improve the visual function.

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Section: Discussionmentioning

confidence: 99%

The Therapeutic Effect of Combination of Orbital Decompression Surgery and Methylprednisolone Pulse Therapy on Patients with Bilateral Dysthyroid Optic Neuropathy

Guo

et al. 2020

Journal of Ophthalmology

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“…In these patients, surgical decompression may be beneficial as a first-line therapy or when medical therapy fails. 33,34 The active phase of TED typically “burns-out” or stabilizes within 1–3 years following the onset of ophthalmopathy. 1 …”

Section: Discussionmentioning

confidence: 99%

Compressive Optic Neuropathy and Repeat Orbital Decompression

Kauh

Gupta

Douglas

et al. 2015

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose To characterize the presenting characteristics, pre-operative clinical activity score (CAS), surgical approach, and visual outcomes in patients with thyroid eye disease undergoing repeat orbital decompression for recurrent or recalcitrant compressive optic neuropathy. Methods The medical records of patients with recurrent or recalcitrant compressive optic neuropathy (CON) undergoing repeat orbital decompressions were retrospectively reviewed. The primary outcome measures included pre- and post-operative Humphrey visual field mean deviation, visual acuity measured in logarithm of the minimal angle of resolution, color vision measured by Ishihara plates, and presence of relative afferent pupillary defect. Details of the surgical procedure and each patient’s CAS at presentation were also recorded. Results Six patients, 9 orbits, with a mean pre-operative CAS of 3.8 were included in this review. The mean time between initial decompression and presentation to our center for recurrent or persistent CON symptoms was 8.6 years (range, 1–15 years). At presentation, the average HVF mean deviation was −16.5 (standard deviation (SD): 8.8), improving to −3.8 (2.4) post-operatively with a mean of 9.3 months follow-up (mean improvement of 75%). Pre-operative visual acuity was 0.34 (0.23) LogMAR, improving to 0.05 (0.10) logMAR with a mean follow up of 10.4 months. Pre- to post-operative comparisons of clinical measures all showed statistically significant improvement (p<0.05). Eight eyes presented with decreased visual acuity (any VA < 20/20), 4 with decreased color vision (any color vision < 11), and 1 with a relative afferent pupillary defect and all of these patients demonstrated improvement following repeat orbital decompression. Conclusions In patients with thyroid eye disease, symptoms of recurrent compressive optic neuropathy occurred up to 15 years following initial orbital decompression underscoring the smoldering, progressive nature of the disease. Repeat decompression which focused on the orbital apex resulted in visual improvement in all 6 patients. Despite clinical evidence of compressive optic neuropathy, the mean CAS of these patients at presentation was only 3.8, highlighting the importance of close monitoring of patients with thyroid eye disease following decompression regardless of the external manifestations of disease activity.

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“…Notfallmäßig bei aktiver EO im Falle einer akuten dysthyreoten Optikusneuropathie (DON) nach ausbleibender Besserung mit intravenöser Gabe von Glucocorticoiden und raschem Visusverlust. 219 220 221 .…”

Section: Orbitale Autoimmunerkrankungenunclassified

Interdisziplinäre Therapie der Erkrankungen der Orbita

Eckstein,

Welkoborsky

2024

Laryngorhinootologie

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ZusammenfassungDie Diagnostik und Therapie von Erkrankungen der Orbita ist eine interdisziplinäre Aufgabe, an der u.a. die Fachdisziplinen HNO-Heilkunde, Augenheilkunde, Radiologie, Strahlentherapie, MKG-Chirurgie, Endokrinologie und Pädiatrie beteiligt sind. Der vorliegende Übersichtsartikel stellt eine Zusammenstellung der häufigsten Erkrankungen dar, mit denen die Fachdisziplinen HNO-Heilkunde und Augenheilkunde interdisziplinär befasst sind. Es werden die akuten entzündlichen Erkrankungen incl. orbitaler Komplikationen, die autoimmunologischen Erkrankungen der Orbita incl. der endokrinen Orbitopathie, und die tumorösen Erkrankungen besprochen. Neben der Diagnostik und der Beschreibung der Klinik wird besonderes Augenmerk auf die interdisziplinäre Therapie gelegt. Abgerundet wird der Übersichtsartikel mit der Beschreibung der wichtigsten chirurgischen Zugangswege zur Orbita, ihre Indikationen und mögliche Komplikationen. Die Autoren haben versucht, trotz der knappen Darstellung die relevanten Fakten zu beschreiben.

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Compression and Stretching in Graves Orbitopathy

Cited by 29 publications

References 13 publications

The Therapeutic Effect of Combination of Orbital Decompression Surgery and Methylprednisolone Pulse Therapy on Patients with Bilateral Dysthyroid Optic Neuropathy

The Therapeutic Effect of Combination of Orbital Decompression Surgery and Methylprednisolone Pulse Therapy on Patients with Bilateral Dysthyroid Optic Neuropathy

Compressive Optic Neuropathy and Repeat Orbital Decompression

Interdisziplinäre Therapie der Erkrankungen der Orbita

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