Dysthyroid optic neuropathy: surgical treatment potential

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PURPOSE

To evaluate the effectiveness of bony orbital decompression in patients with dysthyroid optic neuropathy (DON).

MATERIAL AND METHODS

The study analyzed 255 patients with thyroid eye disease (TED) and bony orbital decompression. Those among them who had DON as an indication for surgery were investigated further. Patients underwent standard ophthalmological examination, computer perimetry, color vision assessment using Ishihara tables, relative afferent pupillary defect (RAPD), computed tomography (CT) of the orbit, and in some cases optical coherence tomography (OCT) of the optic nerve.

RESULTS

Final analysis included 31 patients (52 eyes). On 13 orbits, only lateral wall decompression was performed, and medial wall decompression was the only intervention in 7 orbits. In other cases, these techniques were performed either simultaneously — in 14 orbits, or alternately — in 18 orbits. In the postoperative period, all patients showed significant positive dynamics in terms of visual acuity, visual field, and proptosis. In all cases, decrease of the amount of orbital inflammation was observed. Exophthalmos significantly decreased after surgery and averaged 20.5±3.1 mm, which is 4.7 mm less than the initial one. All changes were statistically significant (p<0.01).

CONCLUSION

Bony orbital decompression is an effective and safe treatment option for DON resistant to high doses of glucocorticoids. In the vast majority of cases, this intervention is the only way to improve and stabilize visual function in this severe category of patients.

Keywords:

thyroid eye disease

dysthyroid optic neuropathy

bony orbital decompression

computerized perimetry

exophthalmos

endonasal orbital decompression

Authors:

Y.O. Grusha

Krasnov Research Institute of Eye Diseases;
Sechenov First Moscow State Medical University

ORCID: 0000-0002-6461-8243

D.S. Ismailova

Research Institute of Eye Diseases

P.A. Kochetkov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

N.A. Andreeva

Research Institute of Eye Diseases

Received:

29.05.2020

Accepted:

13.06.2020

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