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

Abstract

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.

Dysthyroid optic neuropathy: emerging treatment strategies

“…First-line treatment for DON comprises of high-dose ivMP (0.5–1.0 g) pulses given for 3 consecutive days or on every second day, repeated if necessary, and followed by immediate OD in case of insufficient response or disease deterioration. Several studies have analyzed the effectiveness of ivMP therapy in various doses combined with OD [ 15 , 17 – 20 ], but only four studies, including one prospective, have described the efficacy of the recommended DON therapy [ 13 , 14 , 16 , 22 ]. As clear criteria of DON resolution have not been established, diverse indicators of DON improvement have been applied in the published literature, which restricts comparison of the therapeutic outcomes.…”

Elevated Immunoglobulin G4 Levels in Patients with Thyroid Eye Disease and Their Clinical Implications

“…The enrolled patients underwent orbital decompression, which was conducted by the same experienced doctor, followed by intravenous glucocorticoid administration. Importantly, after surgery, patients with sight-threatening TED or active eye disease received methylprednisolone pulse therapy (MPT) at a dose of 1 g of methylprednisolone per day for three consecutive days, which has been proven effective for improving visual function and relieving clinical symptoms compared with MPT alone in a recent study, 11 whereas all other patients received methylprednisolone at a dose of 80 mg per day for three consecutive days. Prednisone was subsequently taken orally at a dose of 30 mg/day and gradually reduced to decrease the active immune attack stimulated by surgical stress and postoperative chemosis.…”

Assessing the relationship between levator palpebrae superioris and thyroid-associated ophthalmopathy using the Dixon-T2WI sequence

“…Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease associated with thyroid disease, with symptoms that may include upper lid retraction (ULR), diplopia, and vision loss, seriously affecting patients' quality of life (1)(2)(3)(4)(5). According to the latest guidelines for TAO management (6,7), the optimal treatment strategy primarily relies on the Clinical Activity Score (CAS) and the European Group on Graves' orbitopathy (EUGOGO) classification of severity.…”