open access

Vol 67, No 2 (2016)
Original papers
Published online: 2016-01-19
Submitted: 2015-05-15
Accepted: 2015-09-08
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Complete recovery of visual acuity as the main goal of treatment in patients with dysthyroid optic neuropathy

Piotr Miśkiewicz, Beata Rutkowska, Anna Jabłońska, Antoni Krzeski, Katarzyna Trautsolt-Jeziorska, Dariusz Kęcik, Justyna Milczarek-Banach, Katarzyna Pirko-Kotela, Agnieszka Samsel, Tomasz Bednarczuk
DOI: 10.5603/EP.a2016.0018
·
Endokrynologia Polska 2016;67(2):166-173.

open access

Vol 67, No 2 (2016)
Original papers
Published online: 2016-01-19
Submitted: 2015-05-15
Accepted: 2015-09-08

Abstract

Introduction: To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy.

Material and methods: The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA< 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment — intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment — endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment — additional MP therapy and/or surgical decompression.

Results: A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves’ orbitopathy clinical activity score (p = 0.035).

Conclusions: By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON. (Endokrynol Pol 2016; 67 (2): 166–173)

Abstract

Introduction: To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy.

Material and methods: The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA< 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment — intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment — endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment — additional MP therapy and/or surgical decompression.

Results: A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves’ orbitopathy clinical activity score (p = 0.035).

Conclusions: By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON. (Endokrynol Pol 2016; 67 (2): 166–173)

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Keywords

dysthyroid optic neuropathy; Graves’ orbitopathy; Graves’ disease; orbital decompression; methylprednisolone; endoscopic intranasal orbital decompression

About this article
Title

Complete recovery of visual acuity as the main goal of treatment in patients with dysthyroid optic neuropathy

Journal

Endokrynologia Polska

Issue

Vol 67, No 2 (2016)

Pages

166-173

Published online

2016-01-19

DOI

10.5603/EP.a2016.0018

Bibliographic record

Endokrynologia Polska 2016;67(2):166-173.

Keywords

dysthyroid optic neuropathy
Graves’ orbitopathy
Graves’ disease
orbital decompression
methylprednisolone
endoscopic intranasal orbital decompression

Authors

Piotr Miśkiewicz
Beata Rutkowska
Anna Jabłońska
Antoni Krzeski
Katarzyna Trautsolt-Jeziorska
Dariusz Kęcik
Justyna Milczarek-Banach
Katarzyna Pirko-Kotela
Agnieszka Samsel
Tomasz Bednarczuk

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