scholarly journals Outcomes following orbital decompression surgery for dysthyroid optic neuropathy associated with Graves’ ophthalmopathy.

2015 ◽  
Vol 14 (3) ◽  
pp. 97-107
Author(s):  
Jerome How Ing Ha ◽  
James Leong ◽  
Peter Martin ◽  
Raf Ghabrial ◽  
Ross Benger
Keyword(s):  
Visual Acuity ◽  
Standard Deviation ◽  
Confidence Interval ◽  
Optic Neuropathy ◽  
P Value ◽  
Decompression Surgery ◽  
Orbital Decompression ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Ophthalmopathy ◽  
Orbital Wall

Purpose: To investigate the outcomes of orbital decompression surgery for dysthyroid optic neuropathy associated with severe Graves’ ophthalmopathy. Design: Ten years (2000-2010) retrospective case series.Methods: Thirty-eight orbits (with dysthyroid optic neuropathy) of 119 surgical orbital decompressions. Patients with dysthyroid optic neuropathy associated with Graves’ ophthalmopathy, who underwent orbital decompression surgery at Sydney Eye Hospital (Sydney, Australia), were investigated for outcome measures.Results: Thirty-five orbits were eligible for data analysis. Orbital decompression surgery improved visual acuity in 29 orbits and maintained visual acuity in four orbits. In patients with dysthyroid optic neuropathy, there was a statistically significant mean improvement in visual acuity of 2.8 lines postoperatively (standard deviation = 3.2; 95% confidence interval 3.9 to 1.7, p-value < 0.05). There were no statistically significant differences invisual acuity amongst different combinations of orbital walls being decompressed, with the majority of orbits had the medial orbital wall decompressed. This may reflect the small number of decompressions performed in each subgroup. Orbital decompression surgery reduced proptosis by a mean of 3.2 mm (standard deviation = 2.9; 95% confidence interval -4.32 to -2.07; p-value < 0.05). Medial and lateral orbital walls decompression resulted in the greatest mean reduction in proptosis. There were no severe visual impairment cases postoperatively (VA worse than 6/60). There were two patients with new onset diplopia postoperatively. There were three orbits with bleeding and one orbit with CSF leakage, all without major sequelae postoperatively.Conclusion: Regardless of surgical access, orbital decompression surgery is effective and safe in the management of dysthyroid optic neuropathy and in reducing proptosis in patients with Graves’ ophthalmopathy.

scholarly journals Preoperative clinical factors and visual outcomes following orbital decompression with dysthyroid optic neuropathy

2020 ◽  
Author(s):  
Mizuki Tagami ◽  
Shigeru Honda ◽  
Atsushi Azumi
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Japanese Patients ◽  
Decompression Surgery ◽  
Orbital Decompression ◽  
Clinical Factors ◽  
Dysthyroid Optic Neuropathy ◽  
Visual Outcomes ◽  
Additional Surgery ◽  
Case Series Study

Abstract Purpose: To investigate preoperative clinical factors and visual outcomes of Japanese patients with dysthyroid optic neuropathy (DON) after urgent orbital decompression. Methods: This retrospective, observational case series study investigated 44 patients who exhibited several preoperative clinical factors that might be associated with the need for urgent orbital decompression due to DON. Additionally, the visual acuity of DON patients was compared between the patients preoperatively and at 1 and 6 months postoperatively. Results: All 44 patients received steroid and with or without radiation therapy, with 27 patients able to avoid undergoing urgent surgery. However, the remaining 17 patients required urgent orbital decompression following a lack of response to the therapy. None of the patients who initially avoided surgery required additional surgery for DON. Factors significantly associated with the need for urgent orbital decompression surgery included: female gender, older age, long disease duration, unilateral significant DON, history of resistance to pulsed steroid therapy, unstable thyroid function, high TRAb(Thyrotrophin receptor antibody )value, poor visual acuity, presence of central diplopia, and presence of corneal problems ( P <0.05 each). The results also showed that postoperative visual outcomes of surgery for DON were acceptable. Conclusion: This study revealed several preoperative clinical factors for DON that appear to be associated with the need for urgent orbital decompression surgery in Japanese patients.

scholarly journals Preoperative clinical factors and visual outcomes following orbital decompression with dysthyroid optic neuropathy

2019 ◽  
Author(s):  
Mizuki Tagami ◽  
Shigeru Honda ◽  
Atsushi Azumi
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Japanese Patients ◽  
Decompression Surgery ◽  
Orbital Decompression ◽  
Clinical Factors ◽  
Dysthyroid Optic Neuropathy ◽  
Visual Outcomes ◽  
Additional Surgery ◽  
Case Series Study

Abstract Purpose: To investigate preoperative clinical factors and visual outcomes of Japanese patients with dysthyroid optic neuropathy (DON) after urgent orbital decompression. Methods: This retrospective, observational case series study investigated 44 patients who exhibited several preoperative clinical factors that might be associated with the need for urgent orbital decompression due to DON. Additionally, the visual acuity of DON patients was compared between the patients preoperatively and at 1 and 6 months postoperatively. Results: All 44 patients received steroid and radiation therapy, with 27 patients able to avoid undergoing urgent surgery. However, the remaining 17 patients required urgent orbital decompression following a lack of response to the therapy. None of the patients who initially avoided surgery required additional surgery for DON. Factors significantly associated with the need for urgent orbital decompression surgery included: female gender, older age, long disease duration, unilateral significant DON, history of resistance to pulsed steroid therapy, unstable thyroid function, poor visual acuity, presence of central diplopia, and presence of corneal problems ( P <0.05 each). The results also showed that postoperative visual outcomes of surgery for DON were acceptable. Conclusion: This study revealed several preoperative clinical factors for DON that appear to be associated with the need for urgent orbital decompression surgery in Japanese patients.

scholarly journals Preoperative clinical factors and visual outcomes following orbital decompression with dysthyroid optic neuropathy

2020 ◽  
Author(s):  
Mizuki Tagami ◽  
Shigeru Honda ◽  
Atsushi Azumi
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Japanese Patients ◽  
Decompression Surgery ◽  
Orbital Decompression ◽  
Clinical Factors ◽  
Dysthyroid Optic Neuropathy ◽  
Visual Outcomes ◽  
Additional Surgery ◽  
Case Series Study

Abstract Background: To investigate preoperative clinical factors and visual outcomes of Japanese patients with dysthyroid optic neuropathy (DON) after urgent orbital decompression.Methods: This retrospective, observational case series study investigated 44 patients who exhibited several preoperative clinical factors that might be associated with the need for urgent orbital decompression due to DON. Additionally, the visual acuity of DON patients was compared between the patients preoperatively and at 1 and 6 months postoperatively.Results: All 44 patients received steroid and with or without radiation therapy, with 27 patients able to avoid undergoing urgent surgery. However, the remaining 17 patients required urgent orbital decompression following a lack of response to the therapy. None of the patients who initially avoided surgery required additional surgery for DON. Factors significantly associated with the need for urgent orbital decompression surgery included: female gender, older age, long disease duration, unilateral significant DON, history of resistance to pulsed steroid therapy, unstable thyroid function, high TRAb(Thyrotrophin receptor antibody )value, poor visual acuity, presence of central diplopia, and presence of corneal problems (P<0.05 each). The results also showed that postoperative visual outcomes of surgery for DON were acceptable.Conclusion: This study revealed several preoperative clinical factors for DON that appear to be associated with the need for urgent orbital decompression surgery in Japanese patients.

Surgical Decompression of the Orbit

2011 ◽  
Author(s):  
J.D. Perry ◽  
Craig Lewis
Keyword(s):  
Radiation Therapy ◽  
Optic Neuropathy ◽  
Eye Disease ◽  
Graves Disease ◽  
Decompression Surgery ◽  
Orbital Decompression ◽  
Eyelid Retraction ◽  
Graves Ophthalmopathy ◽  
Systemic Corticosteroids ◽  
Increased Risk

In 1835 Graves first described the characteristic exophthalmos of thyroid eye disease, and his name has since become synonymous with thyrotoxic ophthalmopathy. Graves disease is relatively common, with a prevalence and incidence of 1% and 0.1%, respectively. Although subtle signs of ophthalmopathy are present in most patients with Graves disease, only 30% have obvious eye findings, and only 5% develop ophthalmopathy severe enough to warrant specific treatment with radiotherapy, immunosuppression, or orbital decompression surgery. Graves disease and Graves ophthalmopathy are more common in females than in males, though males tend to have more severe eye disease. Cigarette smokers have an increased risk of developing Graves disease, an increased risk of developing associated ophthalmopathy, and a progressively increased risk of severe ocular manifestations. While the onset of Graves disease usually occurs when people are in their forties, thyroid optic neuropathy tends to occur in the fifties and sixties, underscoring the importance of careful long-term follow-up of these patients. The ophthalmopathy of Graves disease is usually associated with hyperthyroidism, but it occurs in euthyroid and hypothyroid patients as well. The clinical course of the ophthalmopathy does not directly correlate with the thyroid status, although more than 80% of thyroid patients who develop severe ophthalmopathy do so within 18 months of the detection of the thyroid disease. The early findings of thyroid ophthalmopathy include conjunctival injection, lacrimation, ocular surface irritation, orbital and periorbital swelling, and mild eyelid retraction. Progression of the disease can result in severe orbital congestion, massive enlargement of the extraocular muscles with secondary diplopia, proptosis, compressive optic neuropathy, prominent eyelid retraction, spontaneous subluxation of the globe anterior to the eyelids, and exposure keratopathy. Treatment options for these serious complications of Graves disease include systemic corticosteroids, radiation therapy, and orbital decompression surgery. The role of radiation therapy in the management of Graves ophthalmopathy remains controversial. In 1973, Donaldson et al. first reported results of radiotherapy for Graves ophthalmopathy using a megavoltage linear accelerator. This series and multiple subsequent series have reported favorable results in approximately 60% of patients.

scholarly journals Therapeutic difference between orbital decompression and glucocorticoids administration as the first-line treatment for dysthyroid optic neuropathy: a systematic review

2021 ◽  
Vol 14 (7) ◽  
pp. 1107-1113
Author(s):  
Ming-Na Xu ◽  
◽  
Yun-Hai Tu ◽  
He-Qing Tao ◽  
Ke-Si Shi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Visual Acuity ◽  
Optic Neuropathy ◽  
Controlled Trial ◽  
Case Series ◽  
Cochrane Library ◽  
Clinical Activity ◽  
High Dose ◽  
Orbital Decompression ◽  
Dysthyroid Optic Neuropathy

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy (DON). PubMed, EMBASE, the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcomes were the improvement in visual acuity and responder rate. Secondary outcomes were the proptosis reduction, change in diplopia, and clinical activity score (CAS). One randomized controlled trial, three retrospective case series and one prospective case series met the inclusion criteria. They were divided into intravenous high-dose glucocorticoids (ivGC) group and orbital decompression (OD) group. Both groups demonstrated improvement in visual acuity. In addition, the proportion of patients with improved vision in OD group was higher than that in ivGC group (P<0.001). Post-treatment proptosis reduction was also reported in both groups. Overall, weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively. This study also presented results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in 5 included studies. The most common complication in ivGC group and OD group was Cushing’s syndrome and epistaxis respectively. The present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing proptosis. However, high-quality, large-sample, controlled studies need to be performed in the future.

Endoscopic Orbital Decompression for Graves’ Ophthalmopathy

2005 ◽  
Vol 19 (6) ◽  
pp. 603-606 ◽  
Author(s):  
Jan L. Kasperbauer ◽  
Lucinda Hinkley
Keyword(s):  
Optic Neuropathy ◽  
Cerebrospinal Fluid Leak ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Orbital Decompression ◽  
Orbital Cavity ◽  
Eye Muscle ◽  
Graves Ophthalmopathy ◽  
Fluid Leak ◽  
Eye Muscle Surgery

Background Graves’ ophthalmopathy generates a volume excess for the orbital cavity, which may produce proptosis, pain, exposure keratitis, diplopia, and optic neuropathy. Endoscopic orbital decompression expands the orbital cavity into the ethmoid cavity and medial maxillary sinus. This retrospective study documents the outcomes after endoscopic orbital decompression for patients with Graves’ ophthalmopathy. Methods Data collected included demographic information, symptom resolution, complications related to the surgery, reduction in proptosis, subsequent need for eye muscle surgery, and hospital length of stay. Between July 1989 and April 2003, 62 patients were referred for endoscopic orbital decompression (often unilateral). Results Three patients refused use of their medical records for research purposes. Seventy percent were women; the average age of the study group was 49 years. Preoperatively, 63% of the patients had diplopia and optic neuropathy was noted in 27%. Two patients had a cerebrospinal fluid leak identified and managed during the decompression. No postoperative leaks occurred. Twenty-five percent of patients did not require eye muscle surgery. Forty-eight percent of the patients underwent one procedure to manage diplopia. The average reduction in proptosis was 2.5 mm. Fifty-four percent were managed as an outpatient and 27% underwent a 23-hour observation period. Conclusion This data supports the safety, efficiency, and efficacy of endoscopic orbital decompression for unilateral and bilateral Graves’ ophthalmopathy. Eye muscle surgery frequently will be required to manage diplopia after decompression. (American Journal of Rhinology 19, 603–606, 2005)

scholarly journals Comparison of 2-wall versus 3-wall orbital decompression against dysthyroid optic neuropathy in visual function

Medicine ◽  
2021 ◽  
Vol 100 (8) ◽  
pp. e24513
Author(s):  
Sheng-Nan Cheng ◽  
Yue-Qi Yu ◽  
Ya-Yan You ◽  
Jin Chen ◽  
Xiao-Huan Pi ◽  
...  
Keyword(s):  
Optic Neuropathy ◽  
Visual Function ◽  
Orbital Decompression ◽  
Dysthyroid Optic Neuropathy

scholarly journals Leber hereditary optic neuropathy following head trauma and ocular trauma on contralateral eye: a case report

2020 ◽  
Author(s):  
Hoon Dong Kim
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Dna Analysis ◽  
Ocular Trauma ◽  
Leber Hereditary Optic Neuropathy ◽  
Fellow Eye ◽  
Orbital Wall ◽  
Contralateral Eye ◽  
The Right ◽  
Hereditary Optic Neuropathy

Abstract Purpose To present a case of activation of Leber hereditary optic neuropathy (LHON) following head and ocular trauma of the fellow eye in the patient with no remarkable symptoms and normal visual acuity prior to trauma. Case summary A 31-year-old healthy man was referred to our hospital after a traffic accident. He had blowout fractures of medial and inferior orbital wall of the left eye, subcutaneous hematoma of the left forehead, and bony fragment that compressed the left optic nerve. Initially, best-corrected visual acuity (BCVA) was 20/20 in the right and 20/1000 in the left eyes. Relative afferent pupillary defect of the left eye was apparent, and fundus examination revealed choroidal rupture circumferentially crossing the macular area. Nine months later, the patient complained with gradual vision loss in the right eye, which was the contralateral eye of the ocular trauma. BCVA was 20/200, and perimetry revealed cecocentral scotoma in the right eye. BCVA in both eyes reduced to 20/2000 1 year post-trauma. Visual evoked potentials revealed markedly decreased in amplitudes and elongated latencies for both eyes. Mitochondrial DNA analysis revealed a G11778A mutation; therefore, a diagnosis of activation of LHON followed by trauma was made for the previously unaffected carrier. Conclusions This is a case in which activation of LHON occurred in a healthy carrier following head and ocular trauma of the fellow eye. This observation suggests the possibility that LHON activation in healthy carriers may occur in patients who experience head or ocular trauma even in the fellow eye.

Sign in / Sign up

Export Citation Format

Share Document