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

Korkmaz, Şafak; Konuk, Onur

doi:10.3109/02713683.2015.1008641

Cited by 39 publications

(20 citation statements)

References 23 publications

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“…Visual field defects of DON patients usually have various symptoms but are generally manifested as central scotoma, which can extend to the peripheral area as the disease develops, have different shapes, and be partially ameliorated after effective treatment. Previous studies have shown that decompression surgery can significantly increase the MD value with an average increase of approximately 9.4 to 10.0 dB [35,36]. is study revealed that the MD in operated eyes of DON patients improved more significantly than that in the fellow eyes received MPT alone, as also observed in the previous studies.…”

Section: Discussionsupporting

confidence: 81%

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: Discussionsupporting

confidence: 81%

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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“…Many authors recommend decompression of the medial wall as the best approach for patients with DON [8,9,19]. However, other surgical approaches are also presented: two-wall medial-lateral and three-wall medial-lateral-inferior orbital decompression combined with fat removal [20]. Due to such advantages as good visualisation of the orbital apex, the short time of hospitalisation, and lack of external scars, we performed EIODM.…”

Section: Discussionmentioning

confidence: 99%

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

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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)

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“…A minority of these patients are at risk for hypophasis and corneal disorders. 3 Considering these factors, ICL surgery may be a better option for myopia patients with GO.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of changes in choroidal thickness after implantable collamer lens surgery in high myopia patients with Graves’ Ophthalmopathy (inactive phase)

Liu

Jia

et al. 2020

Preprint

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Background To evaluate the safety and effectiveness of the Visian Implantable Collamer Lens (ICL) implantation in high myopic patients with inactive Graves’ ophthalmopathy (GO) by observing the changes of choroidal thickness (CT). Methods Eight patients (16 eyes) with high myopia accompanied with inactive GO were selected as the experimental group (group A) and 18 high myopic patients (36 eyes) without GO were selected as a control group (group B). The outcomes of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), safety index, efficacy index, intraocular pressure (IOP), vault, corneal endothelial count, and choroidal thickness (CT) were observed. The values of CT were measured using swept-source optical coherence tomography (SS-OCT) scans. Results The UCVA and BCVA in all operated eyes were better than that before surgery. The postoperative safety index and efficacy index were 1.23 and 1.19 in the group A, respectively, and 1.26 and 1.21 in the group B, respectively. In both groups, foveal CT increased significantly in high myopic patients at 2 hours and at 3 months after surgery, compared to preoperative values. The same tendencies were observed in the inner nasal and outer nasal regions. Compared with patients without GO, the increase of CT was more obvious in GO patients, 2 hours postoperatively (P = 0.006) and 3 months postoperatively (P = 0.011). Conclusions The ICL implantation is safe and effective in high myopic patients with inactive GO. Subfoveal and nasal CT may be useful parameters for monitoring the activity of GO patients.

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

Cited by 39 publications

References 23 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

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

Evaluation of changes in choroidal thickness after implantable collamer lens surgery in high myopia patients with Graves’ Ophthalmopathy (inactive phase)

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