Dysthyroid optic neuropathy: surgical treatment potential

Close metadata

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

I.M. Sechenov First Moscow State Medical University (Sechenov University);
Krasnov Research Institute of Eye Diseases

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)

ORCID: 0000-0002-5778-629X

N.A. Andreeva

Research Institute of Eye Diseases

ORCID: 0000-0001-7329-5725

Received:

29.05.2020

Accepted:

13.06.2020

List of references:

Cascone P, Rinna C, Reale G, Calvani F, Iannetti G. Compression and stretching in Graves orbitopathy: emergency orbital decompression techniques. Journal of Craniofacial Surgery. 2012;23(5):1430-1433. https://doi.org/10.1097/SCS.0b013e31825e3acf
Chang EL, Bernardino CR, Rubin PA. Transcaruncular orbital decompression for management of compressive optic neuropathy in thyroid-related orbitopathy. Plastic and Reconstructive Surgery. 2003;112(3):739-747. https://doi.org/10.1097/01.PRS.0000069708.70121.67
Choe CH, Cho RI, Elner VM. Comparison of lateral and medial orbital decompression for the treatment of compressive optic neuropathy in thyroid eye disease. Ophthalmic Plastic and Reconstructive Surgery. 2011;27(1):4-11. https://doi.org/10.1097/IOP.0b013e3181df6a87
Bartalena L, Wiersinga WM, Pinchera A. Graves’ ophthalmopathy: state of the art and perspectives. Journal of Endocrinological Investigation. 2004;27(3): 295-301. https://doi.org/10.1007/BF03345280
Khong JJ, Finch S, De Silva C, Rylander S, Craig JE, Selva D, Ebeling PR. Risk factors for Graves’ Orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) study. Journal of Clinical Endocrinology and Metabolism. 2016;101(7):2711-2720. https://doi.org/10.1210/jc.2015-4294
Neigel JM, Rootman J, Belkin RI, Nugent RA, Drance SM, Beattie CW, Spinelli JA. Dysthyroid optic neuropathy. The Crowded Orbital Apex Syndrome. Ophthalmology. 1988;95(11):1515-1521. https://doi.org/10.1016/s0161-6420(88)32978-7
Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves’ ophthalmopathy. Thyroid. 2002;12(10):855-860. https://doi.org/10.1089/105072502761016476
Blandford AD, Zhang D, Chundury RV, Perry JD. Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management. Expert Review of Ophthalmology. 2017;12(2):111-121. https://doi.org/10.1080/17469899.2017.1276444
Bahn RS. Graves’ ophthalmopathy. The New England Journal of Medicine. 2010;362(8):726-738. https://doi.org/10.1056/NEJMra0905750
Bartalena L, Martino E, Marcocci C, Bogazzi F, Panicucci M, Velluzzi F, Loviselli A, Pinchera A. More on smoking habits and Graves’ ophthalmopathy. Journal of Endocrinological Investigation. 1989;12(10):733-737. https://doi.org/10.1007/BF03350047
Trobe J. Dysthyroid optic neuropathy. Archives of Ophthalmology. 1978; 96(7):1199. https://doi.org/10.1001/archopht.1978.03910060033007
Gasser P, Flammer J. Optic neuropathy of Graves’ disease. A report of a perimetric follow-up. Ophthalmologica. 1986;192(1):22-27. https://doi.org/10.1159/000309607
Henderson JW. Optic neuropathy of Graves’s disease. Transactions of the American Ophthalmological Society. 1957;55:353-365; discussion 365-367.
McKeag D, Lane C, Lazarus JH, Baldeschi L, Boboridis K, Dickinson AJ, Hullo AI, Kahaly G, Krassas G, Marcocci C, Marinò M, Mourits MP, Nardi M, Neoh C, Orgiazzi J, Perros P, Pinchera A, Pitz S, Prummel MF, Sartini MS, Wiersinga WM; European Group on Graves’ Orbitopathy (EUGOGO). Clinical features of dysthyroid optic neuropathy: a European Group on Graves’ Orbitopathy (EUGOGO) survey. British Journal of Ophthalmology. 2007;91(4):455-458. https://doi.org/10.1136/bjo.2006.094607
Jeon C, Shin JH, Woo KI, Kim YD. Clinical profile and visual outcomes after treatment in patients with dysthyroid optic neuropathy. Korean Journal of Ophthalmology. 2012;26(2):73-79. https://doi.org/10.3341/kjo.2012.26.2.73
Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, Perros P, Salvi M, Wiersinga WM. European Group on Graves’ Orbitopathy (EUGOGO). The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. European Thyroid Journal. 2016;5(1):9-26. https://doi.org/10.1159/000443828
Mehta P, Durrani OM. Outcome of deep lateral wall rim-sparing orbital decompression in thyroid-associated orbitopathy: a new technique and results of a case series. Orbit. 2011;30(6):265-268. https://doi.org/10.3109/01676830.2011.603456
Sasim IV, De Graaf MEL, Berendschot TTJM, Kalmann R, Van Isterdael C, Mourits MP. Coronal or swinging eyelid decompression for patients with disﬁguring proptosis in Graves’ orbitopathy? Comparison of results in one center. Ophthalmology. 2005;112(7):13101315. https://doi.org/10.1016/j.ophtha.2005.01.049
Baldeschi L, MacAndie K, Hintschich C, Wakelkamp IM, Prummel MF, Wiersinga WM. The removal of the deep lateral wall in orbital decompression: its contribution to exophthalmos reduction and inﬂuence on consecutive diplopia. American Journal of Ophthalmology. 2005;140(4):642-647. https://doi.org/10.1016/j.ajo.2005.04.023
Bailey KL, Tower RN, Dailey RA. Customized, single-incision, three-wall orbital decompression. Ophthalmic Plastic and Reconstructive Surgery. 2005; 21(1):1-9. https://doi.org/10.1097/01.iop.0000150410.30992.c3
European Group on Graves’ Orbitopathy (EUGOGO), Mourits MP, Bijl H, Altea MA, Baldeschi L, Boboridis K, Currò N, Dickinson AJ, Eckstein A, Freidel M, Guastella C, Kahaly GJ, Kalmann R, Krassas GE, Lane CM, Lareida J, Marcocci C, Marino M, Nardi M, Mohr Ch, Neoh C, Pinchera A, Orgiazzi J, Pitz S, Saeed P, Salvi M, Sellari-Franceschini S, Stahl M, von Arx G, Wiersinga WM. Outcome of orbital decompression for disﬁguring proptosis in patients with Graves’ orbitopathy using various surgical procedures. British Journal of Ophthalmology. 2009;93(11):1518-1523. https://doi.org/10.1136/bjo.2008.149302
Verity DH, Rose GE. Acute thyroid eye disease (TED): Principles of medical and surgical management. Eye (London, England). 2013;27(3):308-319. https://doi.org/10.1038/eye.2012.284
Goldberg RA. The evolving paradigm of orbital decompression surgery. Archives of Ophthalmology. 1998;116(1):95-96. https://doi.org/10.1001/archopht.116.1.95
Goldberg RA, Weinberg DA, Shorr N, Wirta D. Maximal, three-wall, orbital decompression through a coronal approach. Ophthalmic Surgery and Lasers. 1997;28(10):832-843.
Oh SR, Tung JD, Priel A, Levi L, Granet DB, Korn BS, Kikkawa DO. Reduction of orbital inflammation following decompression for thyroid-related orbitopathy. BioMed Research International. 2013;794984. https://doi.org/10.1155/2013/794984
Avetisov SE, Grusha YO, Ismailova DS, Kochetkov PA, Danilov SS, Sviridenko NYu. Surgical rehabilitation of patients with thyroid eye disease: systematic approach. Vestnik oftal’mologii. 2017;133(1):4-10. (In Russ.). https://doi.org/10.17116/oftalma201713314-10
Kochetkov PA. Transethmoidal decompressive orbitotomy in the patients presenting with endocrine ophthalmopathy at the stage of remission: peculiarities of the surgical intervention and the results of exophthalmos correction. Vestnik otorinolaringologii. 2017;82(1):38-42. (In Russ.). https://doi.org/10.17116/otorino201782138-42
Hutchison BM, Kyle PM. Long-term visual outcome following orbital decompression for dysthyroid eye disease. Eye (London, England). 1995;9(5): 578-581. https://doi.org/10.1038/eye.1995.143
Grusha YO, Ismailova DS, Kochetkov PA, Danilov SS. Potentials of Intraoperative Navigation During Balanced Orbital Bony Decompression in Thyroid Eye Disease (Preliminary Results). Vestnik oftal’mologii. 2016;132(4):29-34. (In Russ.). https://doi.org/10.17116/oftalma2016132429-34
Soares-Welch CV, Fatourechi V, Bartley GB, Beatty CW, Gorman CA, Bahn RS, Bergstralh EJ, Schleck CD, Garrity JA. Optic neuropathy of Graves’ disease: results of transantral orbital decompression and long-term follow-up in 215 patients. American Journal of Ophthalmology. 2003;136(3):433-441. https://doi.org/10.1016/s0002-9394(03)00233-2
Siracuse-Lee DE, Kazim M. Orbital decompression: current concepts. Current Opinion in Ophthalmology. 2002;13(5):310-316. https://doi.org/10.1097/00055735-200210000-00004
Michel O, Oberländer N, Neugebauer P, Neugebauer A, Rüssmann W. Follow-up of transnasal orbital decompression in severe Graves’ ophthalmopathy. Ophthalmology. 2001;108(2):400-404. https://doi.org/10.1016/s0161-6420(00)00533-9
Kikkawa DO, Pornpanich K, Cruz RC, Levi L, Granet DB. Graded orbital decompression based on severity of proptosis. Ophthalmology. 2002;109(7): 1219-1224. https://doi.org/10.1016/s0161-6420(02)01068-0
Autoimmunnaya patologiya shchitovidnoy zhelezy I endokrinnaya oftal’mopatiya. Pod red. Dedova I.I., Melnichenko G.A. M.: Izdatel’stvo; 2020. (In Russ.).

Close metadata