McKeag David, Lane Carol, Lazarus John H, Baldeschi Lelio, Boboridis Kostas, Dickinson A Jane, Hullo A Iain, Kahaly George, Krassas Gerry, Marcocci Claudio, Marinò Michele, Mourits Maarten P, Nardi Marco, Neoh Christopher, Orgiazzi Jacques, Perros Petros, Pinchera Aldo, Pitz Susanne, Prummel Mark F, Sartini Maria S, Wiersinga Wilmar M
Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff CF 4 4XN, UK.
Br J Ophthalmol. 2007 Apr;91(4):455-8. doi: 10.1136/bjo.2006.094607. Epub 2006 Oct 11.
This study was performed to determine clinical features of dysthyroid optic neuropathy (DON) across Europe.
Forty seven patients with DON presented to seven European centres during one year. Local protocols for thyroid status, ophthalmic examination and further investigation were used. Each eye was classified as having definite, equivocal, or no DON.
Graves' hyperthyroidism occurred in the majority; 20% had received radioiodine. Of 94 eyes, 55 had definite and 17 equivocal DON. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. Colour vision was reduced in 33 eyes, of which all but one had DON. Half of the DON eyes had normal optic disc appearance. In DON eyes proptosis was > 21 mm (significant) in 66% and visual fields abnormal in 71%. Orbital imaging showed apical muscle crowding in 88% of DON patients. Optic nerve stretch and fat prolapse were infrequently reported.
Patients with DON may not have severe proptosis and orbital inflammation. Optic disc swelling, impaired colour vision and radiological evidence of apical optic nerve compression are the most useful clinical features in this series.
本研究旨在确定欧洲范围内甲状腺功能异常性视神经病变（DON）的临床特征。
一年内，47例DON患者前往欧洲七个中心就诊。采用当地关于甲状腺状态、眼科检查及进一步检查的方案。每只眼睛被分类为患有明确的、可疑的或无DON。
大多数患者为格雷夫斯甲亢；20%曾接受放射性碘治疗。在94只眼中，55只患有明确的DON，17只患有可疑的DON。临床活动评分中位数为4/7，但25%的患者评分为3分或更低，这表明严重炎症并非必要条件。75%的DON患眼最佳矫正视力为6/9（斯内伦视力表）或更差。33只眼睛的色觉减退，其中除一只外均患有DON。一半的DON患眼视盘外观正常。在DON患眼中，66%的患者眼球突出>21mm（显著），71%的患者视野异常。眼眶成像显示88%的DON患者存在眶尖肌肉拥挤。视神经牵拉和脂肪脱垂的报告较少。
DON患者可能没有严重的眼球突出和眼眶炎症。视盘肿胀、色觉受损以及眶尖视神经受压的影像学证据是本系列中最有用的临床特征。
