Abstract
PurposeTo evaluate the effectiveness of steroid-pulse therapy and three-wall orbital decompression in patients with dysthyroid optic neuropathy (DON).MethodsTwenty-five patients (46 eyes) with a diagnosis of DON between 2008 and 2015 were included in the study. The first group (7 patients, 16 eyes) consisted of patients with a steroid-pulse treatment only and the second group (18 patients, 30 eyes) included patients with medical and surgical decompression.ResultsTwenty patients were female; five patients were male. After the diagnosis of DON, all patients were treated with steroid-pulse treatment (intravenous 500 mg prednisolon twice/week for 4 weeks, 250 mg twice/week for 2 weeks) as a first-line treatment (medical decompression). In 30 eyes (18 patients) out of 46 eyes, (25 patients) an orbital decompression was needed to preserve the optic nerve function. In those therapy-resistant cases (surgical decompression group), the orbital decompression led to statistically significant improvements in best-corrected visual acuity (BCVA), protan and tritan value of the color vision (p = 0.007, p < 0.0001, p = 0.019, respectively, comparison of first visit to last visit).ConclusionAccording to our data, the mild cases of DON with better initial visual acuity (in our case series mean: 0.3 logMAR) seem to respond well to steroid treatment. However, therapy-resistant cases with an impaired initial BCVA (in our case series, mean: 0.6 logMAR) seem to need the surgery to preserve the optic nerve function. In conclusion, this retrospective study confirms the effectiveness of surgical decompression in therapy-resistant cases of DON.
Highlights
Graves’ orbitopathy (GO) is an immune-mediated inflammatory disease attributed to glycosaminoglycan depositions by fibroblasts into the retrobulbar tissues resulting in fibrosis [1]
Our goal was to evaluate the effectiveness of surgical decompression among patients that were resistant to the first line of therapy
We retrospectively studied the medical charts of 25 patients, who were treated in the Ludwig-MaximiliansUniversity, Department of Ophthalmology, Section of Evaluation of medical and surgical decompression in patients with dysthyroid optic neuropathy
Summary
Graves’ orbitopathy (GO) is an immune-mediated inflammatory disease attributed to glycosaminoglycan depositions by fibroblasts into the retrobulbar tissues resulting in fibrosis [1]. The disease causes an enlargement of the extraocular muscles and increased volume of the orbital fat [2]. Munich Cancer Registry, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-MaximiliansUniversity, Munich, Germany be classified as mild, moderate to severe or sight threatening [3]. According to the Consensus Statement of the European Group on Graves’ Orbitopathy (EUGOGO), sight-threatening GO is described as dysthyroid optic neuropathy (DON) and/or corneal breakdown requiring immediate intervention to preserve vision [3]. Severe cases of DON, which do not respond to this initial therapy, are often treated with surgical orbital decompression
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