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

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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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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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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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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Modified endoscopic transnasal orbital apex decompression in dysthyroid optic neuropathy

Eye and Vision ◽

10.1186/s40662-021-00238-2 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Yunhai Tu ◽

Mingna Xu ◽

Andy D. Kim ◽

Michael T. M. Wang ◽

Zhaoqi Pan ◽

...

Keyword(s):

Optic Neuropathy ◽

Mixed Models ◽

Linear Mixed Models ◽

Visual Fields ◽

Wilcoxon Test ◽

Mean Deviation ◽

Differential Analysis ◽

Orbital Apex ◽

Dysthyroid Optic Neuropathy ◽

Before And After

Abstract Background To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy. Methods In this retrospective research, forty-two subjects (74 orbits) who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled. Preoperative and postoperative best-corrected visual acuity (BCVA), visual field mean deviation (MD), Hertel exophthalmometry, and new onset diplopia were assessed before and after the intervention. The Wilcoxon test was used for differential analysis. Linear mixed-models’ analyses were conducted to assess the potential predictors for BCVA change. Results Postoperatively, the mean BCVA improved from 0.70 ± 0.62 logMAR to 0.22 ± 0.33 logMAR. BCVA significantly improved in 69 eyes (93%), remained stable in 4 eyes (5%) and deteriorated in 1 eye (1%). MD of visual fields improved from −13.73 ± 9.22 dB to −7.23 ± 7.04 dB. Proptosis decreased from 19.57 ± 3.38 mm to 16.35 ± 3.01 mm. Preoperative BCVA, MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA (P < 0.05) by linear mixed-models’ analyses. Eighteen patients (42.9%) developed new diplopia postoperatively. Conclusion Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.

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Peripapillary and Macular Vessel Density in Dysthyroid Optic Neuropathy: An Optical Coherence Tomography Angiography Study

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.18-25941 ◽

2019 ◽

Vol 60 (6) ◽

pp. 1863 ◽

Cited By ~ 8

Author(s):

Te Zhang ◽

Wei Xiao ◽

Huijing Ye ◽

Rongxin Chen ◽

Yuxiang Mao ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optic Neuropathy ◽

Optical Coherence Tomography Angiography ◽

Vessel Density ◽

Optical Coherence ◽

Dysthyroid Optic Neuropathy

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Retinal nerve fiber layer and ganglion cell complex thickness as a diagnostic tool in early stage dysthyroid optic neuropathy

European Journal of Ophthalmology ◽

10.1177/11206721211062030 ◽

2021 ◽

pp. 112067212110620

Author(s):

Lihua Luo ◽

Dongmei Li ◽

Lixin Gao ◽

Wei Wang

Keyword(s):

Ganglion Cell ◽

Nerve Fiber ◽

Layer Thickness ◽

Optic Neuropathy ◽

Cell Complex ◽

Ganglion Cell Complex ◽

Fiber Layer ◽

Dysthyroid Optic Neuropathy ◽

Nerve Fiber Layer ◽

Nerve Fiber Layer Thickness

Purpose To compare the diagnostic accuracy of peripapillary retinal nerve fiber layer with macular ganglion cell complex thickness as an auxiliary tool for the early diagnosis of dysthyroid optic neuropathy and help assess the effectiveness of the treatment. Methods In this retrospective case–control study, a total of 58 thyroid-associated opthalmopathy patients and 58 healthy participants were enrolled in the study. Thyroid-associated opthalmopathy patients were divided according to the European Group Graves’ Orbitopathy severity classification. The thicknesses of peripapillary nerve fiber layer and macular ganglion cell complex were measured using optical coherence tomography and their correlation with the severity of the disease as well as the effect of the treatment was investigated. Results No statistically significant differences were found between the mild thyroid-associated opthalmopathy group and the control group in both peripapillary nerve fiber layer and macular ganglion cell complex thickness. In the moderate-to-severe thyroid-associated opthalmopathy group, however, Temporal and Nasal peripapillary nerve fiber layer thicknesses were lower compared to the control group ( p = 0.041, p = 0.012), whereas in the sight-threatening thyroid-associated opthalmopathy group Temporal Inferior, Nasal Superior, and mean (G) peripapillary nerve fiber layer thicknesses were larger ( p = 0.000, p = 0.004, p = 0.000). No significant differences were observed in the macular ganglion cell complex thickness among the different severity groups and the control groups ( p > 0.05). After treatment, the mean peripapillary nerve fiber layer thickness decreased whereas mean macular ganglion cell complex thickness showed no significant change in the sight-threatening group. A correlation was established between exophthalmos, best corrected visual acuity, clinical activity score, disease course, and the mean peripapillary nerve fiber layer thickness. The area under curve analysis indicated that mean peripapillary nerve fiber layer thickness can be used as a powerful diagnostic tool in early stage dysthyroid optic neuropathy in thyroid-associated opthalmopathy patients. Conclusion Our study indicates that peripapillary nerve fiber layer act as an auxiliary tool for the early diagnosis of dysthyroid optic neuropathy and helps assess the effectiveness of the treatment.

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