Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss

Mensah, Aurore; Vignal-Clermont, C.; Morel, X; Galatoire, O.; Jacomet, P.V.; Morax, S

doi:10.3109/01676830903104728

Cited by 22 publications

(13 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with DON are older compared to patients with GO but without DON [12]. The average age of patients with DON is about 55 years [15,23,24], which is similar to our results. An older age may be associated with adverse factors related to reconstruction in the muscles, which may affect the therapeutic efficacy.…”

Section: Discussionsupporting

confidence: 90%

Powrót pełnej ostrości wzroku jako główny cel leczenia pacjentów z neuropatią nerwu wzrokowego w przebiegu orbitopatii Gravesa

Miśkiewicz

Rutkowska

Jabłońska

et al. 2016

Endokrynologia Polska

View full text Add to dashboard Cite

Introduction: To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy. Material and methods: The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA < 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment -intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment -endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment -additional MP therapy and/or surgical decompression. Results: A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves' orbitopathy clinical activity score (p = 0.035). Conclusions: By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON. (Endokrynol Pol 2016; 67 (2): 166-173)

show abstract

Section: Discussionsupporting

confidence: 90%

Powrót pełnej ostrości wzroku jako główny cel leczenia pacjentów z neuropatią nerwu wzrokowego w przebiegu orbitopatii Gravesa

Miśkiewicz

Rutkowska

Jabłońska

et al. 2016

Endokrynologia Polska

View full text Add to dashboard Cite

show abstract

“…In another large retrospective study, 8.6% of patients with TED developed DON, and patients with DON were older (54 years versus 46 years)) compared to those without DON[1]. Several other studies also show a strong correlation between age and DON [17,18]. For every decade increase in age of onset of TED, the odds of developing DON may increase by 58%[11].…”

Section: Risk Factorsmentioning

confidence: 99%

“…Age may also affect the response to DON treatment with younger age predicting a better outcome (p=0.049)[19]. Male gender also shows a strong correlation with the development of DON, especially with advancing age[1,4,5,17]. …”

Section: Risk Factorsmentioning

confidence: 99%

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

Blandford

Zhang

Chundury

et al. 2017

Expert Review of Ophthalmology

107

102

View full text Add to dashboard Cite

Introduction Dysthyroid optic neuropathy (DON) is a severe manifestation of thyroid eye disease (TED) that can result in permanent vision loss. Management is complex, multidisciplinary, and involves medical and/or surgical therapies. This review describes current concepts in the epidemiology, pathophysiology, diagnosis, and treatment of DON. Areas covered An extensive review of the literature was performed to detail current concepts on the diagnosis and management of DON. This includes utilization of various medical and surgical modalities for disease management. Expert commentary DON can result in permanent blindness and often requires the use of corticosteroids and surgical decompression. We favor the use of intravenous corticosteroids and a transcaruncular approach when surgical decompression is indicated. The use of orbital radiation for DON is often reserved for patients that are poor surgical candidates and/or patients with refractory disease.

show abstract

“…It is suggested that vascular ischaemia might be involved in the cases with DON. 8 If the response to pulse therapy is poor after a 1-2week period, prompt orbital decompression should be performed. 4,5 The prognosis for DON is highly variable, and to date, no studies have analysed the relationship between the state of thyroid function and the outcome of pulse therapy.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Pulse Corticosteroid Therapy in Euthyroid Optic Neuropathy: A Case Report

Lee

Chang

Tsai³

2012

Neuro-Ophthalmology

View full text Add to dashboard Cite

Herein, the authors report an unusual case of euthyroid optic neuropathy without previous history of endocrinopathy. Visual loss and limitation of extraocular movements developed rapidly in both eyes. An orbital magnetic resonance imaging (MRI) revealed bilateral apical crowding and extraocular muscle hypertrophy with tendon sparing. The restricted visual fields dramatically improved after intravenous pulse corticosteroid therapy. Early diagnosis of euthyroid optic neuropathy and prompt treatment with pulse therapy may result in a favourable visual outcome.

show abstract

Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss

Abstract: DON prognosis is highly variable. Our results suggest that a non-inflammatory element, probably vascular could be involved in atypical DONs. An earlier recognition could prompt to rapid surgical treatment for these patients.

Cited by 22 publications

References 30 publications

Powrót pełnej ostrości wzroku jako główny cel leczenia pacjentów z neuropatią nerwu wzrokowego w przebiegu orbitopatii Gravesa

Powrót pełnej ostrości wzroku jako główny cel leczenia pacjentów z neuropatią nerwu wzrokowego w przebiegu orbitopatii Gravesa

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

Intravenous Pulse Corticosteroid Therapy in Euthyroid Optic Neuropathy: A Case Report

Contact Info

Product

Resources

About