Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
Graefes Arch Clin Exp Ophthalmol. 2024 Jan;262(1):281-293. doi: 10.1007/s00417-023-06187-x. Epub 2023 Aug 2.
To evaluate and compare the changes in orbital soft tissue volume and visual function after endoscopic transnasal medial orbital decompression in patients with active and inactive dysthyroid optic neuropathy (DON).
This prospective, cohort study recruited 112 patients (112 eyes) with DON who were divided into an active and inactive DON group (56 eyes each) by clinical activity scores. All patients underwent endoscopic transnasal medial orbital decompression. The pre- and post-operative orbital soft tissue volumes were measured with high-resolution computed tomography (CT) using Mimics software. Visual function, including best-corrected visual acuity (BCVA), visual field (VF), and visual evoked potential (VEP), was recorded before and after surgery.
Preoperatively, compared with the inactive DON group, the active DON group had greater extraocular muscle volume (EMV) and EMV/orbital volume (OV) ratio, but worse BCVA, VF, and exophthalmos. Postoperatively, although the EMV slightly increased, with the enlarged medial rectus muscle contributing dramatically, the EMV/OV ratio decreased in patients with DON. Besides, visual function including BCVA, VF, VEP and exophthalmos was also improved in both groups after surgery. There were no significant differences in postoperative OV; EMV; EMV/OV ratio; and the BCVA, VF, and VEP parameters between both groups (all P > 0.05).
Patients with DON who did not respond well to steroids, regardless of disease activity, may benefit from orbital decompression via the decrease in the proportion of EMV in OV, especially patients with active DON, who showed more improved visual function than patients with inactive DON.
评估和比较活动期和非活动期甲状腺相关眼病（DON）患者经内镜鼻内眶隔切开术后眼眶软组织体积和视觉功能的变化。
这项前瞻性队列研究纳入了 112 例（112 只眼）DON 患者，根据临床活动评分将其分为活动期和非活动期 DON 组（各 56 只眼）。所有患者均行内镜鼻内眶隔切开术。采用 Mimics 软件对术前和术后高分辨率 CT 测量的眼眶软组织体积进行测量。记录术前和术后的视觉功能，包括最佳矫正视力（BCVA）、视野（VF）和视觉诱发电位（VEP）。
术前与非活动期 DON 组相比，活动期 DON 组眼外肌体积（EMV）和 EMV/眼眶容积（OV）比值更大，但 BCVA、VF 和眼球突出度更差。术后，尽管 EMV 略有增加，主要是由于内侧直肌增大，但 DON 患者的 EMV/OV 比值降低。此外，两组患者术后视觉功能（包括 BCVA、VF、VEP 和眼球突出度）均有所改善。两组术后 OV、EMV、EMV/OV 比值以及 BCVA、VF 和 VEP 参数均无显著差异（均 P>0.05）。
对于类固醇治疗反应不佳的 DON 患者，无论疾病活动度如何，眼眶减压术可能都有益，可通过降低 OV 中 EMV 的比例来改善，特别是活动期 DON 患者，其视觉功能的改善程度优于非活动期 DON 患者。
