Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India.
Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India (A Unit of Medical Research Foundation, Chennai), India.
Indian J Ophthalmol. 2022 Dec;70(12):4419-4426. doi: 10.4103/ijo.IJO_719_22.
To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON).
This is a retrospective, single-center study carried out on consecutive patients presenting with DON over a period of 4 years (2013-2016). The VISA classification was used at the first visit and subsequent follow-ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed.
Thirty-seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty-six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best-corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics.
Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON.
分析伴甲状腺眼病的视神经病变（DON）患者的临床表现、危险因素和治疗结果。
这是一项回顾性、单中心研究，连续纳入了在 4 年期间（2013-2016 年）因 DON 就诊的患者。在初次就诊和后续随访时使用 VISA 分级。根据视神经功能检查和影像学特征进行诊断。分析患者的人口统计学特征、临床表现、危险因素和治疗结果。
本研究共纳入了 26 例患者的 37 只眼。男性显著居多（20 只眼，76.92%）。20 例（76.9%，P=0.011）患者患有甲状腺功能亢进症，15 例（57.69%，P=0.02）为吸烟者。28 只眼（75.6%）视力下降。24 只眼（64.86%）出现色觉异常和相对性传入性瞳孔障碍，30 只眼（81.01%）出现视野缺损。视觉诱发电位（VEP）显示 31 只眼中有 30 只（96.77%，P=0.001）振幅降低，20 只眼（64.51%，P=0.0289）潜伏期延长。26 例（70.27%）患者单独接受静脉注射甲基泼尼松龙（IVMP）治疗，11 例（29.72%）需要手术减压。总体最佳矫正视力提高了 0.2 logMAR 单位。药物治疗组和手术治疗组的预后无统计学差异。4 例患者出现复发性 DON，均为糖尿病患者。
男性、甲状腺功能亢进症和吸烟是发生 DON 的危险因素。VEP、颅顶拥挤和视神经受压是诊断 DON 的敏感指标。糖尿病患者的病程可能更具挑战性，易发生复发性 DON。
