Combination Model of Thyrotrophin Receptor Antibody and Volumetric Orbital Apex Crowding Index as an Indicator of Dysthyroid Optic Neuropathy

Background. Dysthyroid optic neuropathy (DON) is one of the most serious vision-threatening complications of thyroid eye disease (TED); however, accurate and established diagnostic tools for DON are yet lacking. The present study was aimed at identifying new diagnostic factors for the accurate diagnosis of DON. Methods. This retrospective cross-sectional study included 25 TED patients (50 eyes) with enlarged extraocular muscles, no previous anti-inflammatory therapy, and the absence of other vision-affecting diseases between May 2017 and August 2019. Baseline data, such as gender, age, ophthalmological history, thyroid disease and management, TED history including clinical features, management, and long-term results, ophthalmological examinations, serology examinations, and single-photon emission computed tomography/computed tomography (SPECT/CT) results, were extracted. The diagnostic criteria were as follows: (1) best-corrected visual acuity (BCVA) loss coexisting with either of the following—increased latency or reduction of amplitude on visual evoked potential (VEP), impaired color vision, visual field defects, contrast sensitivity impairment, and optic disk swelling—and (2) Barret t ’ s index ≥ 60 % in CT. Univariate and multivariate logistic regression analyses assessed the differences in age, gender, eyes, medical history, clinical activity, thyroid hormone and antibodies, uptake ratio (UR) of extraocular muscles in SPECT/CT, and volumetric orbital apex crowding index (VACI) using the generalized estimation equation. Consequently, the receiver operating characteristic curve (ROC) of the significant factors was constructed. Results. Univariate analysis revealed significant differences in the clinical activity, free triiodothyronine (FT3), free thyroxine (FT4), thyrotrophin receptor antibody (TRAb) levels, the UR of superior and medial rectus, and VACI between DON and TED (without DON) groups. Multivariate regression analysis revealed that TRAb and VACI were significantly different. ROC analysis showed that the univariate models of TRAb or VACI and the multivariate model were effective indicators of DON, while the multivariate model had the highest area under the ROC curve. Conclusion. A combination of TRAb and VACI is an effective indicator for DON.

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

Clinics ◽

10.1590/s1807-59322008000300003 ◽

2008 ◽

Vol 63 (3) ◽

pp. 301-306 ◽

Cited By ~ 12

Author(s):

Mário L. R. Monteiro ◽

Allan C. P. Gonçalves ◽

Carla T. M. Silva ◽

Janete P. Moura ◽

Carolina S. Ribeiro ◽

...

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Optic Neuropathy ◽

Diagnostic Ability ◽

Dysthyroid Optic Neuropathy

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Selective endoscopic decompression of the orbital apex for dysthyroid optic neuropathy

The Laryngoscope ◽

10.1002/lary.20240 ◽

2009 ◽

Vol 119 (6) ◽

pp. 1236-1240 ◽

Cited By ~ 27

Author(s):

Eugene A. Chu ◽

Neil R. Miller ◽

Andrew P. Lane

Keyword(s):

Optic Neuropathy ◽

Orbital Apex ◽

Dysthyroid Optic Neuropathy ◽

Endoscopic Decompression

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Visual field and orbital computed tomography correlation in dysthyroid optic neuropathy due to thyroid eye disease

Orbit ◽

10.1080/01676830.2019.1600150 ◽

2019 ◽

Vol 39 (2) ◽

pp. 77-83

Author(s):

Victoria S. Starks ◽

Katherine L. Reinshagen ◽

Nahyoung G. Lee ◽

Suzanne K. Freitag

Keyword(s):

Computed Tomography ◽

Visual Field ◽

Optic Neuropathy ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Dysthyroid Optic Neuropathy

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Quantification of Orbital Apex Crowding for Screening of Dysthyroid Optic Neuropathy Using Multidetector CT

American Journal of Neuroradiology ◽

10.3174/ajnr.a3029 ◽

2012 ◽

Vol 33 (8) ◽

pp. 1602-1607 ◽

Cited By ~ 22

Author(s):

A.C.P. Gonçalves ◽

L.N. Silva ◽

E.M.M.S. Gebrim ◽

M.L.R. Monteiro

Keyword(s):

Optic Neuropathy ◽

Multidetector Ct ◽

Orbital Apex ◽

Dysthyroid Optic Neuropathy

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Augmented endoscopic orbital apex decompression in dysthyroid optic neuropathy

Eye ◽

10.1038/s41433-019-0464-5 ◽

2019 ◽

Vol 33 (10) ◽

pp. 1613-1618 ◽

Cited By ~ 1

Author(s):

Swati Singh ◽

David S Curragh ◽

Dinesh Selva

Keyword(s):

Optic Neuropathy ◽

Orbital Apex ◽

Dysthyroid Optic Neuropathy

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Monitoring and Predicting Treatment Response of Extraocular Muscles in Grave's Orbitopathy by 99mTc-DTPA SPECT/CT

Frontiers in Medicine ◽

10.3389/fmed.2021.791131 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chengzhi Jiang ◽

Zilong Deng ◽

Jin Huang ◽

Haoyu Deng ◽

Jia Tan ◽

...

Keyword(s):

Computed Tomography ◽

Treatment Response ◽

Single Photon ◽

Photon Emission ◽

Area Under The Curve ◽

Extraocular Muscles ◽

Clinical Activity ◽

Emission Computed Tomography ◽

Chi Square ◽

Efficacy Analysis

Objective: To investigate single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing inflammation in the extraocular muscles (EOMs) and predicting the therapeutic efficacy of periocular glucocorticoid therapy (PGT) for Grave's ophthalmopathy (GO).Materials and Methods: A total of 412 eyes from 206 patients with GO referred for 99mTc-DTPA orbital SPECT/CT were enrolled. Fourteen age- and gender-matched healthy controls (28 eyes) were included. The thickness and uptake ratio (UR) of four EOMs were derived from SPECT/CT. Eighty-six eyes from patients with GO patients received PGT. Changes in SPECT/CT parameters were evaluated between the pre- and post-treatment.Results: 195 eyes and 217 eyes were classified as active and inactive stages by clinical activity score (CAS). Values of the thickness and UR of each EOM, Tmax, and Umax were all significantly higher in the active GO than in the inactive GO and controls (p < 0.01). Among the 86 eyes (48 GO patients) included in the efficacy analysis, 56 eyes and 30 eyes were classified as responders and non-responders. Values of thicknesses and UR of each EOM, the maximum thickness (Tmax), and the maximum UR (Umax) all dropped following PGT in the responders (p < 0.01). Logistic regression analysis identified the Umax as an independent predictor for the responders (p < 0.01). Moreover, the Umax demonstrated incremental predictive value over clinical characters and CAS, as evidenced by the improved area under the curve (0.85 vs. 0.78) and global chi-square (34.12 vs. 18.1).Conclusion:99mTc-DTPA SPECT/CT has the potential to assess inflammatory activity by detecting the involvement of EOMs in GO. Pre-treatment UR provides independent and incremental values for the prediction of PGT treatment response.

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Voxel-Based Morphometric Features of Dysthyroid Optic Neuropathy

10.21203/rs.3.rs-49519/v1 ◽

2020 ◽

Author(s):

Yunhai Tu ◽

Tingting Chen ◽

Bangxun Mao ◽

Chuanwan Mao ◽

Xiaozheng Liu ◽

...

Keyword(s):

Optic Neuropathy ◽

Middle Temporal Gyrus ◽

Clinical Activity ◽

Dysthyroid Optic Neuropathy ◽

Rapid Acquisition ◽

Education Of Patients ◽

Visual Center ◽

Wide Range ◽

The Right ◽

The Brain

Abstract Background: Dysthyroid optic neuropathy (DON) is a serious complication of thyroid-associated ophthalmology (TAO), leading to loss of vision or blindness. Numerous studies had reported thyroid dysfunction affects a wide range of visual pathways in adults, from the retina to the visual center. We aimed to explore if there were abnormalities of gray matter density (GMD) in DON patients.Methods: We collected patients with TAO from The Eye Hospital of Wenzhou Medical University. All patients underwent routine ophthalmic examination, Clinical Activity Score (CAS), intraocular pressure (IOP), exophthalmos, visual field, OCT,and orbital CT scan. 16 patients with DON and 16 patients without DON (N-DON) were enrolled in this study. Age, gender, orbital congestion index and degree of education of patients were matched between the two groups. High-resolution magnetization-prepared rapid acquisition with gradient echo (MPRAGE) scans was performed on all patients. Voxel-based morphometry (VBM) was applied to analyze the T1 weighted images of the brain, based on functional magnetic resonance imaging (FMRI) integrated VBM (FSL-VBM).Results: GDM was significantly decreased in the right middle temporal gyrus, left middle frontal gyrus, left superior frontal gyrus, and right middle frontal orbicular gyrus in the DON when compared to N-DON.Conclusions: The DON can result in reduced GMD in specific areas of the brain. This finding suggests that there may be other mechanisms in Don

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Apical Optic Nerve Compression of Dysthyroid Optic Neuropathy on Computed Tomography

Archives of Ophthalmology ◽

10.1001/archopht.1981.03930010807002 ◽

1981 ◽

Vol 99 (5) ◽

pp. 807-809 ◽

Cited By ~ 80

Author(s):

J. S. Kennerdell ◽

A. E. Rosenbaum ◽

M. H. El-Hoshy

Keyword(s):

Computed Tomography ◽

Optic Nerve ◽

Optic Neuropathy ◽

Nerve Compression ◽

Dysthyroid Optic Neuropathy ◽

Optic Nerve Compression

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Minimal-Access Endoscopic Endonasal Management of Dysthyroid Optic Neuropathy: The Dysthone Study

Neurosurgery ◽

10.1093/neuros/nyz268 ◽

2019 ◽

Vol 85 (6) ◽

pp. E1059-E1067 ◽

Cited By ~ 1

Author(s):

Gilles Zah-Bi ◽

Juliette Abeillon-du Payrat ◽

Anne Laure Vie ◽

Claire Bournaud-Salinas ◽

Emmanuel Jouanneau ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Visual Field ◽

Optic Neuropathy ◽

Wilcoxon Test ◽

Orbital Apex ◽

Endoscopic Endonasal ◽

Dysthyroid Optic Neuropathy ◽

Significant Difference ◽

Matched Data

Abstract BACKGROUND Dysthyroid optic neuropathy (DON) is a devastating complication of thyroid eye disease. Corticosteroids are the primary medical treatment for DON, but some refractory patients may require surgical management. OBJECTIVE To evaluate the efficacy of endoscopic endonasal decompression of the orbital apex in refractory DON. METHODS This study included patients with refractory DON who underwent endoscopic endonasal decompression of the orbital apex from February 2015 to October 2016. A total of 23 orbital apices were decompressed across 17 patients. Visual acuity, ophthalmometry, tonometry, and visual field were evaluated at the preoperative, early and delayed postoperative stages. Statistical analyses were performed using RStudio software. A Wilcoxon test for matched data was performed to determine if there was a statistically significant difference between pre- and postsurgical treatment for the following items: visual acuity, proptosis, visual field, and intraocular pressure. RESULTS Visual acuity improved in 69.5% of the cases with a mean gain of 2.5 points ± 1.6 (P < .05). Additionally, there was an 18.3% reduction in mean proptosis across all cases (P < .05) and a 13.7% decrease in intraocular pressure (P < .05) for all patients. Finally, visual field improved in 82.6% (P < .05) of the cases. The mean time for follow-up was of 6.28 ± 3.7 mo. There were 3 cases of transient postoperative rhinitis and 2 cases of transient diplopia. Two patients experienced recurrence at 4 and 8 mo, respectively. CONCLUSION Endoscopic endonasal decompression of the orbital apex significantly improves visual parameters. As a result, multidisciplinary screening for patients is crucial to ensure prompt surgical decompression.

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