Clinical and Visual Outcomes of Dysthyroid Optic Neuropathy After Surgical Orbital Decompression
Authors' conclusion
Surgical decompression was found to be a very effective treatment for DON. In this study, all clinical parameters improved after surgery and further intervention was rarely needed.
Study context
- Population
- Patients with dysthyroid optic neuropathy (DON) submitted to surgical orbital decompression, 2005–2020, tertiary Thyroid-Eye clinic, Milan, Italyorbits of 56 patients
- Participants
- 88 patients
- Exposure
- First-line surgery vs Steroid-unresponsive
- First-line surgeryn = 33
- Steroid-unresponsiven = 55
- Outcome
- Surgical success: no further decompression needed to preserve vision
Methodological detailssingle-center
- Single-center
Main finding
As reported in the abstract
Surgical success
Surgery successful (orbits)
77
87.5%
Needed further surgery (orbits)
11
12.5%
Observational data: associations, not effects.
Further findings
Response rate by decompression type · higher response rate with balanced decompression
P = 0.04
- Response rate by prior high-dose steroid treatment — Response rate with vs without prior high-dose steroids · High-dose steroids before surgery vs No prior steroids · better response rate with prior steroids
- 96% vs. 73% · P = 0.004
Visual function and Graves' Orbitopathy (GO) activity
- All parameters of visual function improved significantly at follow-up and GO inactivated (clinical activity score (CAS) <3) within 1 month
Pinhole best corrected visual acuity (p-BCVA) by response · 3 months
- All responding orbits had p-BCVA >0.63
- 77
- All non-responding orbits had p-BCVA ≤0.63
- 11
- Visual field parameters and color sensitivity not associated with response
Correlation of final p-BCVA with age
- Inverse correlation, r
- −0.42; p = 0.0003
Original publication
Clinical and Visual Outcomes of Dysthyroid Optic Neuropathy After Surgical Orbital Decompression. Thyroid. Published 22 May 2023. doi:10.
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