Orbital Decompression versus Intravenous High-dose Glucocorticoids in Treatment for Dysthyroid Optic Neuropathy. A Systematic Review of the Literature

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.

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Efficacy of Transcutaneous Transseptal Orbital Decompression in Treating Acute Retrobulbar Hemorrhage and a Literature Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0033-1356754 ◽

2014 ◽

Vol 7 (1) ◽

pp. 17-26 ◽

Cited By ~ 9

Author(s):

Rüdiger Zimmerer ◽

Katrin Schattmann ◽

Harald Essig ◽

Philipp Jehn ◽

Marc Metzger ◽

...

Keyword(s):

Systematic Review ◽

Literature Review ◽

Treatment Options ◽

Orbital Decompression ◽

Review Of The Literature ◽

Orbital Trauma ◽

Time Period ◽

Retrobulbar Hemorrhage

Decreasing visual acuity secondary to orbital trauma may be caused by sudden space-occupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a combination with a systematic review of the literature for a comparison of this method with existing treatment options. For this study the department's database was retrospectively screened for patients with acute RBH who were treated between 2009 and 2011 using the authors’ approach. Patients presenting with RBH were classified into RBH classes I to III according to three different clinical and radiological manifestations of acute RBH. The efficacy of transcutaneous transseptal orbital decompression was assessed by postoperative visual acuities. The literature review was performed by using the MEDLINE database. The time period for the study was between 2009 and 2011 during which 10 patients were diagnosed with suspected RBH and 9 were treated with the authors’ technique. Visual acuities were reconstituted or maintained in almost 86% of patients who were diagnosed and treated according to the authors approach and who survived initial trauma. It was concluded that transcutaneous transseptal orbital decompression provides an efficient and rapid approach for treating patients with acute RBH. By distinguishing three different manifestations of acute RBH, the authors present a diagnostic tool that may facilitate classification of RBH and determination of treatment options.

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

Medicine ◽

10.1097/md.0000000000024513 ◽

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

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

10.21203/rs.2.16908/v2 ◽

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.

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Efficacy of transethmoidal orbital decompression in patients with dysthyroid optic neuropathy

Vestnik otorinolaringologii ◽

10.17116/otorino20208506152 ◽

2020 ◽

Vol 85 (6) ◽

pp. 52

Author(s):

Y.O. Grusha ◽

P.A. Kochetkov ◽

D.S. Ismailova ◽

V.M. Svistushkin ◽

N.V. Zhorzholadze ◽

...

Keyword(s):

Optic Neuropathy ◽

Orbital Decompression ◽

Dysthyroid Optic Neuropathy

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High Dose Rate Brachytherapy for Inoperable Endometrial Cancer: a Case Series and Systematic Review of the Literature

Clinical Oncology ◽

10.1016/j.clon.2021.06.014 ◽

2021 ◽

Author(s):

S. Mutyala ◽

G. Patel ◽

A.C. Rivera ◽

P.N. Brodin ◽

K. Saigal ◽

...

Keyword(s):

Systematic Review ◽

Endometrial Cancer ◽

Dose Rate ◽

Case Series ◽

High Dose Rate ◽

High Dose ◽

Review Of The Literature ◽

High Dose Rate Brachytherapy

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Orbital Volumetry in Graves' Orbitopathy: Muscle and Fat Involvement in relation to Dysthyroid Optic Neuropathy

ISRN Ophthalmology ◽

10.1155/2014/435276 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Moug Al-Bakri ◽

Åse Krogh Rasmussen ◽

Carsten Thomsen ◽

Peter Bjerre Toft

Keyword(s):

Optic Nerve ◽

Optic Neuropathy ◽

Ct Scans ◽

Orbital Decompression ◽

Orbital Fractures ◽

Relative Significance ◽

Dysthyroid Optic Neuropathy ◽

Orbital Fat ◽

Graves Orbitopathy ◽

Fat Volume

Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves’ orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression were retrospectively analyzed. Thirteen patients imaged for unilateral orbital fractures served as controls. Results. The retrobulbar muscle volume was 2.1 ± 0.5 cm3 (mean ± SD) in controls, 4.3 ± 1.5 cm3 in GO without DON, and 4.7 ± 1.7 cm3 in GO with DON. The retrobulbar fat volume was 5.4 ± 1.6 cm3 in controls, 8.7 ± 8.0 cm3 in GO without DON, and 9.4 ± 3.1 cm3 in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (P<0.001), but the volumes in orbits with and without DON were not significantly different. The volume of the optic nerve were similar in the 3 groups. The number of apical, coronal 2 mm thick slices with no fat was 2.9 ± 0.9 in normal orbits, it was 4.1 ± 1.0 in GO orbits without DON and 5.3 ± 0.8 in GO orbits with DON (P=0.007). Conclusion. Apical muscle enlargement may be more important than orbital fat enlargement in the development of DON. However, the fact that apical crowding and muscle enlargement also occur in orbits without DON suggests that other factors also play a role in the development of DON.

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