Hong Kong Eye Hospital, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Surv Ophthalmol. 2024 May-Jun;69(3):403-410. doi: 10.1016/j.survophthal.2023.11.009. Epub 2023 Nov 23.
Diagnosis of dysthyroid optic neuropathy (DON) typically relies on a set of diagnostic clinical features, including decreased visual acuity, impaired color vision, presence of relative afferent pupillary defect, optic disc swelling and ancillary tests including visual field (VF), pattern visual evoked potential (pVEP), and apical crowding or optic nerve stretching on neuroimaging. We summarize various diagnostic methods to establish or rule out DON. A total of 95 studies (involving 4619 DON eyes) met the inclusion criteria. All of the studies considered clinical features as evidence of DON, while most of the studies confirmed DON diagnosis by combining clinical features with ancillary tests. Forty studies (42.1%) used at least 2 out of the 3 tests (VF, pVEP and neuroimaging) and 13 studies (13.7%) used all 3 tests to diagnose DON. In 64 % of the published studies regarding DON, the diagnostic methods of DON were not specified. It is important to note the limitations of relying solely on clinical features for diagnosing DON. On the other hand, since some eyes with optic neuropathy can be normal in one ancillary test, but abnormal in another, using more than one ancillary test to aid diagnosis is crucial and should be interpreted in correlation with clinical features. We found that the diagnostic methods of DON in most studies involved using a combination of specific clinical features and at least 2 ancillary tests.
诊断甲状腺相关眼病性视神经病变（DON）通常依赖于一组诊断临床特征，包括视力下降、色觉受损、相对性传入性瞳孔障碍、视盘肿胀以及辅助检查，包括视野（VF）、图形视觉诱发电位（pVEP）和神经影像学上的尖端拥挤或视神经拉伸。我们总结了各种诊断方法以确定或排除 DON。共有 95 项研究（涉及 4619 只 DON 眼）符合纳入标准。所有研究均将临床特征视为 DON 的证据，而大多数研究通过将临床特征与辅助检查相结合来确诊 DON。40 项研究（42.1%）使用了至少 3 项检查中的 2 项（VF、pVEP 和神经影像学），13 项研究（13.7%）使用了全部 3 项检查来诊断 DON。在 64%的关于 DON 的已发表研究中，DON 的诊断方法并未明确说明。需要注意的是，仅依靠临床特征诊断 DON 存在局限性。另一方面，由于一些视神经病变的眼睛在一项辅助检查中可能正常，而在另一项中异常，因此使用多种辅助检查来辅助诊断非常重要，并且应与临床特征相结合进行解释。我们发现，大多数研究中 DON 的诊断方法涉及使用特定的临床特征和至少 2 项辅助检查的组合。
