Weis Ezekiel, Heran Manraj K S, Jhamb Ashu, Chan Andy K, Chiu Jack P, Hurley Michael C, Rootman Jack
Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Arch Ophthalmol. 2011 Oct;129(10):1332-6. doi: 10.1001/archophthalmol.2011.276.
To evaluate the ability to predict the presence of dysthyroid optic neuropathy (DON) using computed tomography assessment of soft-tissue and clinical features.
A retrospective consecutive case series of patients with thyroid-related orbitopathy.
One hundred eighty-nine orbits from 99 patients were evaluated. Statistically significant clinical predictors of DON on univariate analysis included a difference in intraocular pressure from primary gaze to upgaze (P = .02), the presence of lagophthalmos (P = .04), and inflammation as measured by the VISA (vision, inflammation, strabismus, appearance/exposure) inflammatory scale (P = .004). Dysthyroid optic neuropathy was inversely related to the marginal reflex distance (P = .01), levator function (P = .02), total ductions (P = .003), and interpalpebral fissure (P = .04). Statistically significant radiologic predictors determined on univariate analysis included apical crowding (P < .001), presence of enlarged tendons (P = .004), increasing total rectus diameter (P = .02), and presence of small, low densities within the recti muscles (P = .04). Multivariate analysis found only total ductions (P = .02) and marginal reflex distance (P = .04) determined on clinical examination and apical crowding shown on computed tomography (P = .003) to be significantly associated with DON. Receiver operating characteristic curves were used to evaluate the ability of the clinical and radiologic assessment, as well as the combination of these assessments, to predict DON. All 3 models were strong predictors of DON, with no statistically significant differences in the area under the receiver operating characteristic curve among them (P = .14).
Total ductions, marginal reflex distance, and apical crowding observed on computed tomography scans are able to predict the presence of DON with high sensitivity, specificity, positive predictive value, and negative predictive value. Eyelid ptosis is a novel predictor of DON.
通过计算机断层扫描评估软组织及临床特征，评估预测甲状腺功能异常性视神经病变（DON）存在的能力。
对甲状腺相关眼眶病患者进行回顾性连续病例系列研究。
评估了99例患者的189只眼眶。单因素分析中，DON具有统计学意义的临床预测因素包括从第一眼位到上视眼内压的差异（P = 0.02）、兔眼的存在（P = 0.04）以及通过VISA（视力、炎症、斜视、外观/暴露）炎症量表测量的炎症（P = 0.004）。甲状腺功能异常性视神经病变与边缘反射距离（P = 0.01）、提上睑肌功能（P = 0.02）、总眼球运动度（P = 0.003）及睑裂（P = 0.04）呈负相关。单因素分析确定的具有统计学意义的放射学预测因素包括眶尖拥挤（P < 0.001）、肌腱增粗的存在（P = 0.004）、直肌总直径增加（P = 0.02）以及直肌内小的低密度影的存在（P = 0.04）。多因素分析发现，临床检查确定的仅总眼球运动度（P = 0.02）和边缘反射距离（P = 0.04）以及计算机断层扫描显示的眶尖拥挤（P = 0.003）与DON显著相关。采用受试者工作特征曲线评估临床和放射学评估以及这些评估的组合预测DON的能力。所有3种模型都是DON的强预测指标，它们之间受试者工作特征曲线下面积无统计学显著差异（P = 0.14）。
计算机断层扫描观察到的总眼球运动度、边缘反射距离和眶尖拥挤能够以高敏感性、特异性、阳性预测值和阴性预测值预测DON的存在。眼睑下垂是DON的一个新的预测因素。
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