Korean J Ophthalmol.  2012 Apr;26(2):73-79. 10.3341/kjo.2012.26.2.73.

Clinical Profile and Visual Outcomes after Treatment in Patients with Dysthyroid Optic Neuropathy

• Jeon C
• Shin JH
• Woo KI
• Kim YD

• KMID: 1364858
• DOI: http://doi.org/10.3341/kjo.2012.26.2.73

Abstract

PURPOSE
To report the clinical data and visual outcomes after treatment of patients with dysthyroid optic neuropathy (DON).
METHODS
We retrospectively reviewed the medical records and orbital images of 40 patients (65 eyes) with DON and analyzed the visual outcomes after treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression.
RESULTS
The study included 21 men and 19 women, with 10 (25%) being diabetic patients. Visual field test results revealed defects in 88.7% of DON eyes; afferent pupillary defects in 63.2%; reduced color vision in 78.5%; and abnormal visual evoked potentials in 84%. Orbital imaging showed moderate to severe apical crowding in 95% of the orbits and intracranial fat prolapse in 24.2%. Median best corrected visual acuity improved from 0.4 to 1.0 after one year of treatment (p < 0.001). We noted more improvement in vision with the use of decompressive surgery than with non-surgical methods (p < 0.05). Recurrences occurred in 7 patients who had not received orbital radiotherapy.
CONCLUSIONS
Visual field defects and apical crowding seen on orbital imaging were the most sensitive indicators for the detection of DON. Treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression effectively improved visual outcomes in cases of DON.

Keyword

Decompression; Optic neuropathy; Radiation; Steroid; Thyroid eye diseases

MeSH Terms

Adult
Aged
Combined Modality Therapy
*Decompression, Surgical
Diabetes Complications
Evoked Potentials, Visual
Female
*Graves Ophthalmopathy/pathology/surgery/therapy
Humans
Male
Middle Aged
Pulse Therapy, Drug
Pupil Disorders
*Radiotherapy
Recovery of Function
Recurrence/prevention & control
Retrospective Studies
Steroids/*administration & dosage
Visual Acuity
Visual Fields
Young Adult

Figure

• 

  Fig. 1 Best corrected decimal visual acuity of 65 eyes of 40 patients with dysthyroid optic neuropathy.

• 

  Fig. 2 Change of logarithmically to the minimum angle of resolution (logMAR) visual acuity from time of diagnosis to 2 years after the start of treatment. Improvement of vision was statistically significant during the initial month (p < 0.001) and between 6 and 12 months (p < 0.05) after the initiation of treatment.

• 

  Fig. 3 Comparison of change in average visual acuity between the decompression group (26 eyes of 16 patients) and the non-decompression group (39 eyes of 24 patients). logMAR = logarithmically to the minimum angle of resolution.

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