Research progress of dysthyroid optic neuropathy / 国际眼科杂志(Guoji Yanke Zazhi)

Dysthyroid optic neuropathy is an important secondary pathological condition of thyroid-associated ophthalmopathy, characterized clinically by several clinical manifestations, including reduced visual acuity, impairment of color vision, relative afferent pupillary defect, and optic disk edema or atrophy. Ophthalmological auxiliary examination shows abnormal vision field and visual evoked potential, etc., and imagining examination shows orbital apex crowding, which can assist diagnosis. The pathogenesis of this disease is still unclear. With previous studies proposing that it was related to optic nerve compression, stretch, and ischemia. Treatment methods include high-dose intravenous glucocorticoid, orbital decompression, orbital radiation therapy, and biological agent. This article systematically reviews the research progress on the epidemiological characteristics, pathogenesis, diagnosis, and treatment of this disease, with a view to providing useful reference for future in-depth clinical practice and scientific research.

Visual function changes of dysthyroid optic neuropathy and ROC curve analysis for early diagnostic indicators / 中南大学学报(医学版)

OBJECTIVES@#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.@*METHODS@#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.@*RESULTS@#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.@*CONCLUSIONS@#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.

Dysthyroid optic neuropathy: Demographics, risk factors, investigations, and management outcomes

Purpose: To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON). Methods: This is a retrospective, single?center study carried out on consecutive patients presenting with DON over a period of 4 years (2013–2016). The VISA classification was used at the first visit and subsequent follow?ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed. Results: Thirty?seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty?six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best?corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics. Conclusion: Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON.

Therapeutic outcomes of high-dose intravenous steroids in the treatment of sight-threatening Graves′ ophthalmopathy / 中华内分泌代谢杂志

Graves′ ophthalmopathy is a complex autoimmune disease characterized by inflammation and the orbital connective/adipose tissue with infiltration. About 3% to 7% of patients with Graves′ ophthalmopathy can have severe or very severe course of disease. In severe forms of Graves′ ophthalmopathy, there might occur considerable exophthalmos complicated in some cases with corneal ulceration due to incomplete closure of the eyelids and (or) pressure on optic nerve leading to neuropathy (dysthyroid optic neuropathy). The patient′s visual acuity and the color perception decreased sharply , which seriously affected the patients quality of life. In this paper, we explore effective therapies by compared the effects of high-dose intravenous steroids for the treatment of sight-threatening Graves′ ophthalmopathy in 2 cases.

Therapeutic outcomes of high-dose intravenous steroids in the treatment of sight-threatening Graves' ophthalmopathy / 中华内分泌代谢杂志

Graves' ophthalmopathy is a complex autoimmune disease characterized by inflammation and the orbital connective/adipose tissue with infiltration. About 3％to 7％of patients with Graves' ophthalmopathy can have severe or very severe course of disease. In severe forms of Graves' ophthalmopathy, there might occur considerable exophthalmos complicated in some cases with corneal ulceration due to incomplete closure of the eyelids and ( or ) pressure on optic nerve leading to neuropathy ( dysthyroid optic neuropathy) . The patient's visual acuity and the color perception decreased sharply , which seriously affected the patients quality of life. In this paper, we explore effective therapies by compared the effects of high-dose intravenous steroids for the treatment of sight-threatening Graves' ophthalmopathy in 2 cases.

Retrospective clinical cross-sectional study on dysthyroid optic neuropathy / 第二军医大学学报

Objective To clarify the clinical features of dysthyroid optic neuropathy (DON), so as to provide evidence for early diagnosis and treatment of DON. Methods The general characteristics and data of thyroid function conditions, ophthalmologic and imaging examinations were retrospectively analyzed in 98 patients (196 eyes) with DON diagnosed from Jan. 2015 to Dec. 2017 in our hospital. According to relevant references, the 196 eyes were diagnosed as having definite, equivocal, or no DON. All patients with equivocal or definite DON in at least one eye were recruited. Results Among 98 DON patients, 59 were male and 39 were female, and the ratio of male to female was 1.51: 1. The average age of 98 patients was (52.51 ±10.25) years old, ranging from 34 to 74 years old. All patients had a history of smoking or passive smoking. Ninetysix patients had hyperthyrea. Of 98 patients, 80 had definite DON and 18 equivocal, with 122 eyes being definite, 56 being equivocal and 18 having no DON. The mean clinical activity score was (4.44±1.53) in all patients, of whom 30 cases scored≤3. Of 178 definite and equivocal DON eyes, 142 eyes had best corrected visual acuity≤0.6, 130 had reduced colour vision, 38 had optic disc oedema, 56 had optic disc pallor, and 84 had normal optic disc. Seventeen out of 18 eyes without DON had normal optic disc. The exophthalmos≤21 mm was found in 38 definite DON eyes. Orbital imaging examination showed that all 80 definite DON patients had crowded orbital apex syndrome, with 67 cases (83.75%) having bilateral and 13 (16.25%) having unilateral one. Conclusion Older age, male, smoking and hyperthyrea are risk factors of DON. Crowded orbital apex syndrome is the most important pathological basis of DON. Impaired visual acuity, reduced colour vision and optic disc swelling are the most specific clinical features of DON.

Predicting dysthyroid optic neuropathy using computed tomography volumetric analyses of orbital structures

OBJECTIVE: To evaluate the ability of orbital apex crowding volume measurements calculated with multidetector-computed tomography to detect dysthyroid optic neuropathy. METHODS: Ninety-three patients with Graves' orbitopathy were studied prospectively. All of the patients underwent a complete neuro-ophthalmic examination and computed tomography scanning. Volumetric measurements were calculated from axial and coronal contiguous sections using a dedicated workstation. Orbital fat and muscle volume were estimated on the basis of their attenuation values (in Hounsfield units) using measurements from the anterior orbital rim to the optic foramen. Two indexes of orbital muscle crowding were calculated: i) the volumetric crowding index, which is the ratio between soft tissue (mainly extraocular muscles) and orbital fat volume and is based on axial scans of the entire orbit; and ii) the volumetric orbital apex crowding index, which is the ratio between the extraocular muscles and orbital fat volume and is based on coronal scans of the orbital apex. Two groups of orbits (with and without dysthyroid optic neuropathy) were compared. RESULTS: One hundred and two orbits of 61 patients with Graves' orbitopathy met the inclusion criteria and were analyzed. Forty-one orbits were diagnosed with Graves' orbitopathy, and 61 orbits did not have optic neuropathy. The two groups of orbits differed significantly with regard to both of the volumetric indexes (p<0.001). Although both indexes had good discrimination ability, the volumetric orbital apex crowding index yielded the best results with 92% sensitivity, 86% specificity, 81%/94% positive/negative predictive value and 88% accuracy at a cutoff of 4.14. CONCLUSION: This study found that the orbital volumetric crowding index was a more effective predictor of dysthyroid optic neuropathy than previously described computed tomography indexes were.

Neuropatía óptica distiroidea como manifestación de orbitopatía de Graves / Dysthyroid optic neuropathy: report of one case

Dysthyroid optic neuropathy is an uncommon and severe form of presentation of Graves ophtalmopathy, caused by compression and elongation of the optic nerve. Use of high dose steroids is the treatment of choice. Decompressive surgery is reserved for refractory cases. We report a 41 years old female with a dysthyroid optic neuropathy that appeared 18 years after the diagnosis of Graves disease, manifested by a marked reduction in visual acuity. Orbit CAT scan did not show compression or elongation of optic nerve. She was treated with prednisone 60 mg per day, obtaining a complete remission after 19 days of treatment. After 90 days of follow up with low doses of steroids, the patient remains asymptomatic.

Diagnostic ability of barrett's index to detect dysthyroid optic neuropathy using multidetector computed tomography

OBJECTIVES: The objective of this study was to evaluate the ability of a muscular index (Barrett's Index), calculated with multidetector computed tomography, to detect dysthyroid optic neuropathy in patients with Graves' orbitopathy. METHODS: Thirty-six patients with Graves' orbitopathy were prospectively studied and submitted to neuro-ophthalmic evaluation and multidetector computed tomography scans of the orbits. Orbits were divided into two groups: those with and without dysthyroid optic neuropathy. Barrett's index was calculated as the percentage of the orbit occupied by muscles. Sensitivity and specificity were determined for several index values. RESULTS: Sixty-four orbits (19 with and 45 without dysthyroid optic neuropathy) met the inclusion criteria for the study. The mean Barrett's index values (± SD) were 64.47 percent ± 6.06 percent and 49.44 percent ± 10.94 percentin the groups with and without dysthyroid optic neuropathy, respectively (p<0.001). Barrett's index sensitivity ranged from 32 percent to 100 percent, and Barrett's index specificity ranged from 24 percent to 100 percent. The best combination of sensitivity and specificity was 79 percent/72 percent for BI=60 percent (odds ratio: 9.2). CONCLUSIONS: Barrett's Index is a useful indicator of dysthyroid optic neuropathy and may contribute to early diagnosis and treatment. Patients with a Barrett's index >60 percent should be carefully examined and followed for the development of dysthyroid optic neuropathy.

Endoscopic Orbital Decompression for Dysthyroid Optic Neuropathy / 대한이비인후과학회지

Many techniques have been employed for the treatment of dysthyroid optic neuropathy. With the development of intranasal endoscopic skills, endoscopic orbital decompression is now performed as one of surgical treatments of the disease. Orbital decompression was performed by endoscopic approach on 3 orbits in 2 patients. Proptosis was reduced 3 mm each in 2 orbits of a patient by Hertel measurement and visual acuity was improved in both patients. The endonasal endoscopic approach provided visual improvement without the morbidity of the traditional Walsh-Ogura method.