Dysthyroid Optic Neuropathy Research Articles

Surgical Outcomes of Standardized Endoscopical Deep Medial Orbital Decompression in Dysthyroid Optic Neuropathy

Introduction: The aim of the study was to standardize the endoscopic deep medial orbital decompression surgery for better relief of optic nerve compression in dysthyroid optic neuropathy (DON). Methods: A total of 128 eyes from patients received the standardized endoscopic deep medial orbital decompression surgery were recruited in this study. The efficacy of the procedure was assessed at a 1-month follow-up by the best-corrected visual acuity (VA), visual field (VF), and visual evoked potential (VEP). Clinical data were collected to explore the factors that affected visual recovery. Oxygen saturation of retinal blood vessels, retinal thickness, and vessel density were measured to demonstrate the potential recovery mechanisms. Results: After surgery, the ratio of extraocular muscle volume in the orbital apex to orbital apex volume significantly decreased from 44.32 ± 22.31% to 36.82 ± 12.02% (p < 0.001). 96.87% of eyes’ final VA improved; average VA improved from 0.93 ± 0.73 to 0.50 ± 0.60 at 1 week (p < 0.001) and 0.40 ± 0.53 at 1 month (p < 0.001). Postoperatively, VF and VEP also improved, the oxygen saturation of retinal arteries increased, and the retinal thickness was reduced. Preoperative VA, visual impairment duration, and clinical activity score evaluation were associated with visual recovery. Conclusion: In this study, we standardized the endoscopic deep medial orbital decompression, of which key point was to relieve pressure in the orbital apex and achieved satisfactory visual recovery in DON patients.

Extraocular muscle enlargement in dysthyroid optic neuropathy

ObjectifExaminer le volume musculaire extraoculaire en présence d'une ophtalmopathie thyroïdienne (OT) avec ou sans neuropathie optique dysthyroïdienne (NOD). NatureÉtude de cohorte rétrospective. ParticipantsPatients présentant une OT dont les orbites ont fait l'objet d'une tomographie assistée par ordinateur. MéthodesLes muscles extraoculaires ont été segmentés manuellement en coupes axiales et coronales consécutives, et leur volume a été calculé en additionnant les aires de chacune des coupes et en multipliant par l’épaisseur de la coupe. Ont été recueillies les données suivantes : caractéristiques démographiques des patients, présentation de l'affection, examens de la fonction thyroïdienne et taux d'anticorps. RésultatsOn a évalué les images de 200 orbites. Le volume du droit médial, du droit latéral, du groupe des muscles supérieurs, du droit inférieur et de l'oblique supérieur était significativement plus important en présence de NOD que dans les orbites qui présentaient une OT sans NOD (p < 0,01 pour l'ensemble des mesures). On n'a enregistré aucune différence significative quant au volume de l'oblique inférieur (p = 0,19). L'augmentation du volume de l'oblique supérieur correspondait à la probabilité la plus élevée de NOD. Pour chaque augmentation de 100 mm3 du volume de l'oblique supérieur, du droit latéral, du droit inférieur, du droit médial et du groupe des muscles supérieurs, la probabilité de NOD était 1,58, 1,25, 1,20, 1,16 et 1,14 fois plus élevée. ConclusionTous les volumes des muscles extraoculaires, exception faite de l'oblique inférieur, étaient significativement supérieurs en présence de NOD. L'augmentation du volume de l'oblique supérieur était associée à la plus grande probabilité de NOD; ce paramètre semble donc constituer un nouveau marqueur de NOD.

Macular blood flow changes in dysthyroid optic neuropathy after high-dose intravenous pulse methylprednisolone (IVMP)

Objective: To investigate the changes in macular ໿vessel density (VD) of the superficial layer of retina (SLR) and deep layer of retina (DLR) in dysthyroid optic neuropathy (DON) after high-dose intravenous pulse methylprednisolone (IVMP). Materials and Methods: Eighteen DON patients (29 eyes) who completed high-dose IVMP and 16 healthy individuals (32 eyes) were enrolled in this study. Optical coherence tomography angiography (OCTA) image analysis and comprehensive ophthalmic examinations were performed, including the SLR macular whole-image VD (SLR-mwiVD) and DLR-mwiVD, best-corrected visual acuity (BCVA), the mean deviation of visual field (VF-MD), pattern standard deviation of visual field (VF-PSD) and the other parameters. Results: The SLR-mwiVD (41.39 ± 4.71 vs. 48.13 ± 3.68, p < 0.001) and DLR-mwiVD (40.77 ± 5.85 vs. 49.14 ± 7.02, p < 0.001) were decreased in DON compared to control eyes. After IVMP, visual function parameters were improved, and SLR-mwiVD (49.41 ± 3.18, p < 0.001) and DLR-mwiVD (50.41 ± 4.04, p < 0.001) were increased in the DON group compared to pretreatment. The increased SLR-mwiVD and DLR-mwiVD were significantly correlated with improvements in BCVA (Log MAR: from 0.62 ± 0.49 to -0.01 ± 0.03, p < 0.001), VF-MD (from – 6.89 ± 2.89 dB to – 1.75 ± 1.29 dB, p < 0.001) and VF-PSD (from 4.38 ± 2.52 dB to 2.32 ± 1.64 dB, p < 0.001). Conclusion: The increase in macular VD was significantly correlated with the improvement in visual function in DON after IVMP. Macular VD changes on OCTA may be a useful indicator for the response in DON after IVMP.

A study on the clinical profile of patients with thyroid-related orbitopathy presenting to a tertiary eye care institute

Thyroid-associated orbitopathy is an autoimmune disorder that is the most frequent extrathyroidal involvement of Graves’ disease but sometimes occurs in euthyroid or hypothyroid patients. Patients with Thyroid associated disease present with chemosis, superior limbic keratoconjunctivitis, proptosis, lid retraction and oedema, restricted extraocular muscle, and dysthyroid optic neuropathy. This study was an observational cross-sectional study which included all the patients with all age groups who attended the Outpatient Department of a Tertiary Care Hospital, Ajmer, with signs and symptoms of thyroid-associated orbitopathy or diagnosed with thyroid-associated orbitopathy with no history of multiple endocrine disorder. 95 subjects satisfying the inclusion and exclusion criteria were enrolled in the study.The mean age of study participants was 43.93± 12.25 years. Age ranges from 21 years to 80 years. 59 (62.1%) were female. Among all patients 69 (72.6%) were hyperthyroid, 19 (20.0%) were euthyroid and 7 (7.4%) were euthyroid. 5 (5.2%) presented with dysthyroid optic neuropathy. 40(42.10%) cases were of active thyroid eye disease (TED) and the remaining 55 (57.8%) were inactive cases. Out of all active presenters, 30% were having Clinical Active Scoring (CAS) ≥4.Middleage group and female sex were the common clinical profile of the patients of TED. When active and Inactive TED groups were compared, findings such as Average CAS, dysthyroid optic neuropathy, average Hertel’s value, and presenting signs were significantly higher in the active group.

Evaluation of lamina cribrosa and peripapillary vascular density in thyroid orbitopathy and effect of intravenous methylprednisolone therapy

ObjectifÉvaluer les modifications de la tête du nerf optique en présence d'orbitopathie thyroïdienne (OT) et examiner les effets de l'administration intraveineuse (i.v.) de méthylprednisolone (MTP) sur ces modifications. MéthodesOnt été inclus 82 yeux de 41 patients présentant une OT avec ou sans neuropathie optique dysthyroïdienne (NOD) et 40 yeux de 40 sujets témoins en bonne santé. L’épaisseur et la profondeur de la lame criblée (ELC et PLC, respectivement), l’épaisseur de la couche de fibres nerveuses rétiniennes péripapillaires (pRNFLT, pour peripapillary retinal nerve fiber layer thickness) et la densité vasculaire dans le réseau capillaire péripapillaire radial ont été mesurées à l'aide de la tomographie par cohérence optique (OCT) et de l'angiographie-tomographie par cohérence optique (OCTA). On a également réalisé un examen du champ visuel et de l'exophtalmie. Les patients qui présentaient une NOD de même qu'une atteinte évolutive autre que la NOD ont reçu la MTP par voie i.v. pendant 12 semaines, après quoi l'effet du traitement a été évalué. RésultatsLa densité vasculaire péripapillaire a diminué en présence de NOD, comparativement aux autres groupes (p < 0,001 dans tous les cas); aucune différence n'a été enregistrée entre les groupes quant à la pRNFLT (totale, de l'hémisecteur supérieur et de l'hémisecteur inférieur). L'ELC a diminué dans le groupe OT (p < 0,001). Après l'administration i.v. de MTP, on a noté une hausse de l'ELC et de la meilleure acuité visuelle corrigée. Le taux d'anticorps anti-récepteurs de la TSH, la pression intraoculaire, la pRNFLT de l'hémisecteur supérieur et l'exophtalmie ont tous diminué, comparativement à ce qui a été enregistré chez les témoins (p = 0,012; p = 0,008; p = 0,043 et p < 0,001, respectivement). ConclusionsLa pRNFLT n'augmente pas nécessairement en présence de NOD. On peut observer une modification de la morphologie de la lame criblée dans l'OT. L'administration i.v. de MTP a eu un effet positif sur l'ELC mais pas sur la densité vasculaire dans le réseau capillaire péripapillaire radial ni sur la PLC.

Dysthyroid optic neuropathy: a case series at a tertiary ophthalmic referral centre.

To determine risk factors and treatment outcomes in dysthyroid optic neuropathy (DON) at a single tertiary ophthalmic centre. Retrospective audit of DON patients who have received intravenous methylprednisolone (IVMP) therapy at Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 2015 to October 2021. Study included 24 patients (58% female) with an average age of 59.8 ± 14.7 years at DON diagnosis. Majority (92%) had Graves' hyperthyroidism and 77% had a smoking history. At diagnosis, average visual acuity (VA) of worse eye was LogMAR 0.46, and 48% had relative afferent pupillary defect. Proptosis (89%) and diplopia (73%) were most commonly present at diagnosis. 78% showed predominantly extra-ocular muscle enlargement, and apical crowding (52%) on radiology. 38% (n = 9/24) responded to IVMP alone, 58% (n = 14/24) progressed to surgical orbital decompression. The average total cumulative dose of IVMP during DON treatment was 6.8 ± 1.9 g. 29% required further treatment after IVMP and surgical decompression, 4 (17%) had additional radiotherapy, and three (13%) required immuno-modulatory therapy. Average final VA was LogMAR 0.207, with all patients having inactive TED at final follow-up (mean 1.7 years). In refractory DON cases, 71% retained VA ≥ 6/9 and 48% had DON reversal. DON patients typically present in late 50s, with a smoking history and predominant extra-ocular muscle enlargement. High-dose IVMP fully resolved DON in only 38%. A considerable proportion required urgent orbital decompression. Most patients retained good vision at final follow-up.

Analysis of the efficacy of transnasal endoscopic annulus of zinn area decompression in the treatment of dysthyroid optic neuropathy

Objective: To evaluate the early efficacy and safety of transnasal endoscopic decompression in the annulus of zinn (AZ) region for refractory dysthyroid optic neuropathy (DON) and to preliminarily analyze the correlated factors of postoperative visual function outcome. Methods: From July 2021 to January 2023, 35 patients (56 eyes) with DON who received AZ area decompression in Peking University Third Hospital were included retrospectively, including 9 males (13 eyes) and 26 females (43 eyes), aging (52.2±12.0) years. Among them, 35 eyes underwent two-wall (medial and inferior) orbital decompression using an endonasal endoscopic approach, while 21 eyes received three-wall (medial, lateral, and inferior) orbital decompression through a combined approach. Key parameters such as best corrected visual acuity (BCVA), visual field (MD value), eyeball prominence, intraocular pressure, and complications were recorded. Postoperative data were collected one month after surgery. The statistical analysis was performed using paired t-test and Spearman correlation analysis. Results: Significant outcomes were observed post surgery in BCVA, visual field, intraocular pressure and proptosis (t value was 8.37, 6.17, 4.50, and 9.20, respectively, all P<0.001). The reduction in proptosis was statistically significant between the 2-wall and 3-wall orbital decompression groups (t=-2.82, P=0.007). Changes in BCVA, visual field, and intraocular pressure before and after surgery was greater in the 3-wall orbital decompression group compared to 2-wall orbital decompression group, although the difference was not statistically significant (all P>0.05). Change in postoperative visual acuity and visual field was significantly positively correlated with preoperative visual acuity and preoperative visual field (all P<0.001). Similarly, change in intraocular pressure and proptosis was positively correlated with preoperative intraocular pressure and preoperative protrusion (all P<0.001). Preoperative diplopia was reported in seven patients (20.0%), and two new cases (5.7%) were noted post-operation, which resolved within 3 months after surgery. Conclusions: Endoscopic endonasal decompression of the AZ area is a safe and effective surgical treatment for DON, with notable improvements in BCVA. Furthermore, three-orbital wall decompression seems to yield better outcomes in terms of eye retraction.

Optic nerve sheath infiltration in dysthyroid optic neuropathy.

To assess the association of optic nerve sheath (ONS) infiltration, fat infiltration, and scleral enhancement with active thyroid eye disease (TED) and dysthyroid optic neuropathy (DON). Thyroid eye disease patients who had axial and coronal fat-suppressed contrast enhanced T1-weighted magnetic resonance imaging (MRI) imaging performed were included. Optic nerve sheath infiltration was defined by the presence of thickening and circumferential enhancement of the optic nerve sheath. Clinical assessments were performed by orbital surgeons or neuro-ophthalmologists and the disease activity (active/inactive) and presence or absence of dysthyroid optic neuropathy were recorded. The study population consisted of 76 orbits from 38 patients with a mean age of 53 ± 15 years, with 25 (66%) being female. Optic nerve sheath infiltration was present in 28 (37%) orbits, fat infiltration in 37 (49%) and scleral enhancement in 14 (18%) orbits. ONS infiltration (OR 19.8, p < 0.01), fat infiltration (OR 5.2, p < 0.01) and scleral enhancement (OR 12.2, p = 0.01) were all significantly associated with active clinical disease. Patients with ONS infiltration had a significantly higher odds of dysthyroid optic neuropathy (OR 3.4, p < 0.05). Fat infiltration (OR 2.8, p = 0.1) and scleral enhancement (OR 2.3, p = 0.23) were not significantly associated with DON. Optic nerve sheath infiltration may be a predictor of dysthyroid optic neuropathy. Intraorbital fat infiltration and scleral enhancement may be used to detect active TED. These radiological findings may serve as useful diagnostic and stratification tools in evaluating TED patients.

Computed Tomography and Magnetic Resonance Imaging of the Orbit in the Diagnosis and Treatment of Thyroid-Associated Orbitopathy – Experience from Practice. A Review

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included. Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

OCT and OCTA in dysthyroid optic neuropathy: a systematic review and meta-analysis

PurposeTo explore the current research about the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in dysthyroid optic neuropathy (DON).MethodsStudies in the literature that focused on...

HbA1c: an independent risk factor for dysthyroid optic neuropathy.

We aimed to explore the frequencies of islet β-cell autoantibodies and insulin resistance (IR) in thyroid-associated ophthalmopathy (TAO) and identify specific diabetes mellitus (DM) indicators as early predictors for dysthyroid optic neuropathy (DON). Ninety-eight TAO patients (57 DON and 41 non-DON patients) and 48 healthy control (HC) participants were recruited for this prospective cross-sectional study. Serum thyroxine, serum thyroid autoantibodies, serum humoral immune markers against islet β-cell, fasting plasma glucose (FPG), fasting serum insulin (FINS), fasting c-peptide (FCP), and glycosylated hemoglobin A1 (HbA1c) were measured. Logistic regression analysis was used to evaluate the correlation of patients' age, body mass index (BMI), FPG, HbA1c, and related indexes of islet β-cell function to the occurrence of DON. The DON group had higher FPG (P<0.001, 0.016) and HbA1c (P<0.0001, P<0.001) levels than the HC and non-DON groups. The homeostasis model assessment (HOMA)-IR level was the highest in the DON group (HC 2.15 ± 0.89, non-DON 2.41 ± 1.24, and DON 2.82 ± 2.65), while the HOMA-β level was the lowest (HC 101.8 ± 44.75%, non-DON 102.9 ± 54.61%, and DON 88.29 ± 52.75%), with no significant differences (P=1, P>0.05). On univariate analysis, age (P=0.006), BMI (P=0.022), history of steroid use (P=0.014), FPG (P=0.013), and HbA1c (P=0.001) levels were significantly associated with the presence/absence of DON. In addition, after adjusting for potential confounds, the HbA1c level was an independent factor associated with DON (P=0.009, OR=4.012). HbA1c is an independent risk factor for DON. Given the interconnected link between thyroid dysfunction and DM, the use of HbA1c as a potential biomarker for DON warrants further investigation.

FRI547 Orbital Surgery In Moderate-To-Severe Graves´Ophthalmopathy: Institutional Experience

Abstract Disclosure: L. Delfino: None. Z. Anabela: None. V. Ilera: None. V. García Roel: None. A. Reyes: None. A.T. Gauna: None. Management of moderate-to-severe Graves´ophtalmopathy (GO) depends mainly on the degree of soft tissue inflammation. While immunosuppressive therapy is indicated in the active phase, orbital surgery (OS) is reserved for sequelae disease. Indication of OS during active phase is sight-threatening GO not responding to steroids. Although not a common practice, OS during active disease has been performed in our institution as a second line therapy. We aim to describe our experience in patients that underwent OS for active and inactive GO. Methods: retrospective study. Activity and severity were defined according to 2021 EUGOGO guidelines. Response to OS was classified as: adequate (improvement of GO), partial (stabilization without progression) and poor (progression of GO). Results: 32 patients underwent OS, 59.4% were women, median age 47 years (25-67), 48.4% smokers. Management of hyperthyroidism comprised antithyroid drugs in 19 cases (59.3%), radioiodine in 11 (34.4%) and thyroidectomy in 2. At the time of surgery 27 patients (84.4%) were euthyroid, 4 (12.5%) subclinical hyperthyroid and 1 (3.1%) hypothyroid. GO was inactive in 18 (56.3%) of cases and active in 14 (43.7%). All patients with active GO and 6 patients with inactive GO had been treated with weekly intravenous steroids as proposed by Kahaly or with 1 g methylprednisolone/d for 3 days. Indications for OS were rehabilitation for aesthetic/functional sequelae in 53.1%, dysthyroid optic neuropathy in 15.6%, poor response to steroids in 15.6% and others (optic nerve elongation, exposure keratopathy, ocular subluxation) in 15.6% of cases. At the time of OS 16 patients received concomitant steroids, 10 with active and 6 with inactive GO but positive anti-TSH receptor antibodies (TRAb) and risk factors. Response to treatment was considered adequate in 81.3%, stable in 12.5% and poor in 6.3% (one active and one inactive GO). Before OS TRAb were positive in 90.6% of patients. After surgery TRAb decreased in 64.3%, remained stable in 10.7% and were negative in 25% of cases. No patient with negative TRAb before OS presented positive levels after procedure. The percentage of patients with negative TRAb was significantly higher post-surgery [90.6% vs 65.6%, X2 (1) =5, p=0.025]. Evolution of TRAb was not related with concomitant use of steroids for OS. Conclusions: in our experience, response to OS was satisfactory in more than 90% of cases. In patients with active GO and inadequate response to previous intravenous steroids treatment, OS achieved favorable results in more than 80%. TRAb levels decreased or became negative in most cases, with no increments after surgery. We consider that OS can be an appropriate second-line treatment option in cases of unfavorable response to steroids and inaccessibility to other treatment modalities, and that positivity of TRAb should not be a condition to preclude OS. Presentation: Friday, June 16, 2023

Real-World Experience With Teprotumumab in Patients With Dysthyroid Optic Neuropathy.

Teprotumumab, an insulin-like growth factor I receptor inhibitory antibody, improved proptosis, diplopia, inflammatory signs/symptoms, and quality of life in patients with active thyroid eye disease (TED) in clinical trials. The trials excluded patients with dysthyroid optic neuropathy (DON). Recently, many case reports and case series have reported the successful use of teprotumumab to treat DON. Here, we review the data from published cases and our clinical experience in treating patients having DON with teprotumumab. A literature search was conducted of patients with DON treated with teprotumumab from January 2020 through September 2022. Data from DON patients from the authors' (M.A.T. and C.A.B.) clinical practice were included. Primary outcome measure was mean (SD) improvements for visual acuity, color vision, and visual fields. Improvements in proptosis and clinical activity score (CAS) and diplopia were compared before and after teprotumumab administration. Ten observational studies/case reports were identified along with 2 patients in our practice. In all, there were 24 active TED patients with DON (37 eyes) who were treated with teprotumumab. Mean (SD) age was 66.5 (13.6) years and 13 (54%) were females, disease duration ranged from 2 months to >15 years. 22/24 patients had none, minimal improvement or progression of visual loss with intravenous/oral corticosteroids, orbital decompression (n = 9), and orbital radiation (n = 2). There were 2 patients who received teprotumumab as the only therapy. Overall, 88% (21/24) reported improvement in visual acuity after teprotumumab and in 75% (18/24), improvement in vision was observed after just 2 infusions of teprotumumab. Three eyes had decompression surgery in close proximity to teprotumumab infusions and were excluded from analyses. Mean (SD) improvement in visual acuity was 3.73 lines (SD 3.74), range 2-15 lines in 33 eyes. The mean (SD) improvement in the mean deviation on visual field testing in 15 eyes was 5.6 db (3.0 db). Mean (SD) improvement in proptosis was 4.37 mm (SD: 2.11) (20 patients, 32 eyes); and clinical activity score: mean reduction of 5.1 (1.3) for 18 patients. Teprotumumab was well tolerated in all but one patient. Adverse events reported included fatigue, dysgeusia, hearing loss, nausea, hyperglycemia, and muscle spasms. Teprotumumab is an effective treatment for DON in our experience and in published cases in whom treatment with steroids, surgery, or orbital radiation was unsuccessful.

Imaging of dysthyroid optic neuropathy.

Dysthyroid optic neuropathy (DON) is a sight-threatening complication of thyroid eye disease and can lead to permanent vision loss if not treated early. Imaging with computed tomography (CT) or magnetic resonance imaging (MRI) can aid in the diagnosis and early recognition of DON. A number of quantitative and qualitative imaging features have been associated with DON. This article summarises the definition, prevalence, and utility of these radiological findings in the diagnosis of DON.

Predictive factors of development of dysthyroid optic neuropathy among individuals with thyroid-eye disease.

Dysthyroid optic neuropathy (DON) is a severe visual loss condition in thyroid eye disease (TED). This study aimed to identify factors affecting moderate-to-severe TED or DON in Thai populations. We retrospectively reviewed the records of 230 TED patients at Rajavithi Hospital between January 1, 2017, and October 31, 2022. Mild, moderate-to-severe TED, and DON were found in 60.43%, 22.61%, and 16.96% of participants, respectively. Female predominance was noted in all groups. The proportion of older age, hyperthyroidism, current smokers, and type 2 diabetes mellitus (T2DM) participants were significantly higher in the DON group. Multivariable logistic-regression analysis revealed that hyperthyroidism and current smoking significantly increased the risk of developing moderate-to-severe TED (OR = 3.001, p = 0.010, and OR = 4.153, p = 0.015, respectively). Exophthalmos was the strongest predictor (OR = 6.834, p < 0.001). Regarding DON risk factors, older age (≥55 years) had OR = 3.206 (p = 0.003), hyperthyroidism had OR = 3.228 (p = 0.005), and being a current smoker had OR = 3.781 (p = 0.011). T2DM posed the greatest risk of DON development (OR = 4.111, p = 0.004). Hyperthyroidism and current smoking are significant risk factors for moderate-to-severe TED and DON. TED patients with diabetes mellitus or older age should be closely monitored and informed about their risk of developing DON.

Surgical management of dysthyroid optic neuropathy: A systematic review

ObjectiveThere is currently no recommendation on the optimal surgical management for dysthyroid optic neuropathy (DON). The aim of this study is to systematically review the surgical management of DON and its outcome on visual acuity (VA). Data sourcesMEDLINE, Cochrane Library, and clinicaltrials.gov Review MethodsA systematic review of studies about the surgical management of DON was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if preoperative and postoperative VA in logMAR (Logarithm of the Minimum Angle of Resolution) were available. ResultsFifteen articles were included in the study accounting for 669 orbits. The mean VA improvement was of 0.44 logMAR overall, 0.41 logMAR for 1-wall, 0.41 logMAR for 2-wall, and 0.55 logMAR for 3-wall decompressions. The mean reduction in exophthalmos was 4.9 mm overall, 4.3 mm for 1-wall, 4.54 mm for 2-wall, and 6.02 for 3-wall decompressions. The mean new onset diplopia (NOD) rate was 19.84% overall, 19,12% for 1-wall, 20.75% for 2-wall, and 19.83% for 3-wall decompressions. ConclusionThe results are limited due to the high number of biases in the included studies. It seems that 3-wall decompression offers the best VA improvement and proptosis reduction although also the highest NOD and complications rate. Two-wall balanced decompression or 1-wall inferomedial decompression seems to be effective with less morbidity.

Automated evaluation of parapapillary choroidal microvasculature in thyroid eye disease.

The purpose of the study was to investigate the parapapillary choroidal microvasculature in thyroid eye disease (TED) using optical coherence tomography angiography (OCTA). Only one eye of each subject was included in the study. Patients with TED and controls were included in the study. Participants were divided into three groups: control, inactive TED (ITED) and active TED (ATED). OCTA scans of the optic discs were obtained in a 4.5 × 4.5-mm rectangular area. Radial peripapillary capillary (RPC) density and peripapillary retinal nerve fibre layer (pRNFL) thickness were automatically calculated by the device software. Parapapillary choroidal microvasculature (PPCMv) density was automatically calculated using MATLAB software. Forty-one patients with TED and 40 controls were included in the study. RPC density was significantly decreased in the ATED and dysthyroid optic neuropathy (DON) group compared to the controls and ITED group. There was significant increase in pRNFL in the ATED group. PPCMv density increased in the ATED group compared to the controls in whole ring area. The RPC density was significantly correlated with the TSHr Ab level (r < -0.396, p < 0.001). Clinical activity score correlated positively with PPCMv density (r = 0.349, p = 0.001) but negatively with RPC density (r = -0.321, p = 0.004). Changes in peripapillary microvascular perfusion may play a role in the development of DON. As the severity of TED increases with clinical activity, so do the changes observed in peripapillary parameters. The decrease in RPC density may be due to compression caused by optic disc oedema, which may result in reduced blood flow. The increase in PPCMv density may be related to factors such as orbital congestion.

Visual function changes of dysthyroid optic neuropathy and ROC curve analysis for early diagnostic indicators.

Dysthyroid optic neuropathy (DON) is a class of diseases that makes seriously endanger to the vision of patients with thyroid-associated ophthalmopathy. This study aims to observe the visual function changes in patients with DON, and to evaluate the diagnostic value of indicators diagnosing DON. A retrospective study was conducted on 98 eyes of 49 patients with dysthyroid optic neuropathy (DON) who were treated in Xiangya Hospital of Central South University from January 2017 to December 2019. All patients were received the examination of best corrected visual acuity (BCVA), Humphrey visual field, visual evoked potential (VEP), and contrast sensitivity. Ninety-eight eyes were divided into a DON group (45 eyes) and a non-DON group (53 eyes). T-test was used to compare the related indicators between the 2 groups. The sensitivity and specificity of each indicator were analyzed by receiver operating characteristic (ROC) curve. The BCVA and visual field index (VFI) of the DON group were significantly lower than those of the non-DON group (all P<0.05). The mean deviation (MD) and pattern standard deviation (PSD) of the DON group were significantly higher than those of the non-DON group (all P<0.05). The low frequency contrast sensitivity (CSL), medium frequency contrast sensitivity (CSM), and high frequency contrast sensitivity (CSH) of the DON group were significantly lower than those of the non-DON group (all P<0.05), with CSH being particularly prominent. Compared with the non-DON group, at spatial frequencies of 15°, 30°, and 60°, the amplitude of N135 wave was significantly reduced, and the latency of N75 wave, P100 wave, and N135 wave was significantly prolonged in the DON group (all P<0.05); at spatial frequencies of 15° and 30°, the amplitude of P100 wave was significantly reduced in the DON group (P<0.05). The ROC curve analysis results showed that the area under the curve (AUC) of VFI, CSL, CSM, CSH and 15° P100 amplitude diagnosing DON were 0.812, 0.841, 0.880, 0.784, and 0.791, respectively, with CSM possessing the highest sensitivity and specificity. The visual function of patients with DON is decreased. VFI, contrast sensitivity of low, medium, and high frequency, and 15° P100 wave amplitude might be effective indicators for early diagnosis of DON.

Clinical and visual outcomes of dysthyroid optic neuropathy after surgical orbital decompression

Clinical and visual outcomes of dysthyroid optic neuropathy after surgical orbital decompression

Comparison of surgical effect in active and inactive Dysthyroid Optic Neuropathy after Endoscopic Transnasal Medial Orbital Decompression.

To evaluate and compare the changes in orbital soft tissue volume and visual function after endoscopic transnasal medial orbital decompression in patients with active and inactive dysthyroid optic neuropathy (DON). This prospective, cohort study recruited 112 patients (112 eyes) with DON who were divided into an active and inactive DON group (56 eyes each) by clinical activity scores. All patients underwent endoscopic transnasal medial orbital decompression. The pre- and post-operative orbital soft tissue volumes were measured with high-resolution computed tomography (CT) using Mimics software. Visual function, including best-corrected visual acuity (BCVA), visual field (VF), and visual evoked potential (VEP), was recorded before and after surgery. Preoperatively, compared with the inactive DON group, the active DON group had greater extraocular muscle volume (EMV) and EMV/orbital volume (OV) ratio, but worse BCVA, VF, and exophthalmos. Postoperatively, although the EMV slightly increased, with the enlarged medial rectus muscle contributing dramatically, the EMV/OV ratio decreased in patients with DON. Besides, visual function including BCVA, VF, VEP and exophthalmos was also improved in both groups after surgery. There were no significant differences in postoperative OV; EMV; EMV/OV ratio; and the BCVA, VF, and VEP parameters between both groups (all P > 0.05). Patients with DON who did not respond well to steroids, regardless of disease activity, may benefit from orbital decompression via the decrease in the proportion of EMV in OV, especially patients with active DON, who showed more improved visual function than patients with inactive DON.