Fearington Forrest W, Peraza Lazaro R, Hernandez-Herrera Gabriel A, Awadallah Andrew S, Stokken Janalee K, Wagner Lilly H, Bradley Elizabeth A, Stan Marius N, Bothun Erick D, Tooley Andrea A
Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
Department of Otolaryngology- Head & Neck Surgery, Mayo Clinic, Rochester, MN, USA.
Thyroid Res. 2025 Jul 1;18(1):33. doi: 10.1186/s13044-025-00248-5.
Patients with thyroid eye disease may develop dysthyroid optic neuropathy (DON), which is commonly treated via orbital decompression surgery. This study aims to identify preoperative factors that can predict postoperative best corrected visual acuity (BCVA) in patients with DON and to classify recovery rates based on these prognostic factors.
We retrospectively assessed thirty-two patients (51 orbits) diagnosed with DON who underwent orbital decompression.
Univariate and multivariate mixed effects analysis revealed that preoperative BCVA was the strongest predictor of postoperative BCVA (p < 0.0001). Other significant prognostic factors were extraocular muscle hypertrophy (p = 0.01), visual field mean deviation (p = 0.009), retinal nerve fiber layer thickness (p = 0.01), and afferent pupillary defect (p < 0.0001). We then stratified outcomes by the strongest prognostic factor, preoperative BCVA, which demonstrated that 17 of 19 (89.5%) orbits with preoperative BCVA < logMAR 0.20 (20/32 Snellen) achieved acceptable final vision (defined as better than logMAR 0.40 or 20/50 Snellen), compared to 16 of 20 (80%) orbits with preoperative BCVA logMAR 0.20-0.60 (20/32-20/80 Snellen), and only 3 of 11 (27.3%) orbits with preoperative BCVA > logMAR 0.60 (20/80 Snellen). Patients with preoperative BCVA of logMAR 0.60 (20/80 Snellen) or better had > 80% chance of recovering with acceptable final vision after surgery, compared to a < 30% chance for patients with preoperative BCVA worse than logMAR 0.60 (20/80 Snellen).
These results highlight preoperative BCVA as the strongest predictor of DON outcome and suggest that earlier intervention prior to substantial BCVA deterioration may yield better results.
3: Retrospectively Registered.
甲状腺眼病患者可能会发生甲状腺功能异常性视神经病变（DON），通常通过眼眶减压手术进行治疗。本研究旨在确定能够预测DON患者术后最佳矫正视力（BCVA）的术前因素，并根据这些预后因素对恢复率进行分类。
我们回顾性评估了32例（51只眼眶）诊断为DON并接受眼眶减压手术的患者。
单因素和多因素混合效应分析显示，术前BCVA是术后BCVA的最强预测因素（p < 0.0001）。其他显著的预后因素包括眼外肌肥大（p = 0.01）、视野平均偏差（p = 0.009）、视网膜神经纤维层厚度（p = 0.01）和传入性瞳孔障碍（p < 0.0001）。然后，我们根据最强的预后因素——术前BCVA对结果进行分层，结果显示，术前BCVA < logMAR 0.20（20/32 Snellen）的19只眼眶中有17只（89.5%）获得了可接受的最终视力（定义为优于logMAR 0.40或20/50 Snellen），术前BCVA为logMAR 0.20 - 0.60（20/32 - 20/80 Snellen）的20只眼眶中有16只（80%），而术前BCVA > logMAR 0.60（20/80 Snellen）的11只眼眶中只有3只（27.3%）。术前BCVA为logMAR 0.60（20/80 Snellen）或更好的患者术后有超过8０%的机会获得可接受的最终视力恢复，而术前BCVA低于logMAR 0.60（20/80 Snellen）的患者这一机会小于30%。
这些结果突出了术前BCVA是DON预后的最强预测因素，并表明在BCVA显著恶化之前进行早期干预可能会产生更好的结果。
3级：回顾性注册研究。
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