Management of Very Severe Graves' Orbitopathy: Dysthyroid Optic Neuropathy and Corneal Breakdown

2017 ◽  
pp. 193-201
Author(s):  
Antonella Boschi ◽  
Nicola Currò
Keyword(s):  
Optic Neuropathy ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Orbitopathy

scholarly journals Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy

Clinics ◽  
2012 ◽  
Vol 67 (11) ◽  
pp. 1327-1334 ◽  
Author(s):  
ACP Gonçalves ◽  
EM Gebrim ◽  
ML Monteiro
Keyword(s):  
Optic Neuropathy ◽  
Imaging Studies ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Orbitopathy

scholarly journals Orbital Volumetry in Graves' Orbitopathy: Muscle and Fat Involvement in relation to Dysthyroid Optic Neuropathy

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Moug Al-Bakri ◽  
Åse Krogh Rasmussen ◽  
Carsten Thomsen ◽  
Peter Bjerre Toft
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Ct Scans ◽  
Orbital Decompression ◽  
Orbital Fractures ◽  
Relative Significance ◽  
Dysthyroid Optic Neuropathy ◽  
Orbital Fat ◽  
Graves Orbitopathy ◽  
Fat Volume

Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves’ orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression were retrospectively analyzed. Thirteen patients imaged for unilateral orbital fractures served as controls. Results. The retrobulbar muscle volume was 2.1 ± 0.5 cm3 (mean ± SD) in controls, 4.3 ± 1.5 cm3 in GO without DON, and 4.7 ± 1.7 cm3 in GO with DON. The retrobulbar fat volume was 5.4 ± 1.6 cm3 in controls, 8.7 ± 8.0 cm3 in GO without DON, and 9.4 ± 3.1 cm3 in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (P<0.001), but the volumes in orbits with and without DON were not significantly different. The volume of the optic nerve were similar in the 3 groups. The number of apical, coronal 2 mm thick slices with no fat was 2.9 ± 0.9 in normal orbits, it was 4.1 ± 1.0 in GO orbits without DON and 5.3 ± 0.8 in GO orbits with DON (P=0.007). Conclusion. Apical muscle enlargement may be more important than orbital fat enlargement in the development of DON. However, the fact that apical crowding and muscle enlargement also occur in orbits without DON suggests that other factors also play a role in the development of DON.

scholarly journals Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey

2006 ◽  
Vol 91 (4) ◽  
pp. 455-458 ◽  
Author(s):  
D. McKeag ◽  
C. Lane ◽  
J. H Lazarus ◽  
L. Baldeschi ◽  
K. Boboridis ◽  
...  
Keyword(s):  
Clinical Features ◽  
Optic Neuropathy ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Orbitopathy ◽  
European Group

Subclinical dysthyroid optic neuropathy: tritan deficiency as an early sign of dysthyroid optic neuropathy

2020 ◽  
pp. bjophthalmol-2020-316433
Author(s):  
Aylin Garip-Kuebler ◽  
Kathrin Halfter ◽  
Lukas Reznicek ◽  
Annemarie Klingenstein ◽  
Siegfried Priglinger ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Colour Vision ◽  
Definitive Diagnosis ◽  
Early Sign ◽  
Dysthyroid Optic Neuropathy ◽  
Graves Orbitopathy ◽  
The Mean ◽  
Pathological Sign ◽  
Optic Nerve Compression

PurposeThe aim of this research was to investigate the subclinical findings of dysthyroid optic neuropathy (DON) and to look for early indicators for optic nerve compression in patients with Graves’ orbitopathy.Patients and MethodsIn this observational, retrospective study, the medical charts of 24 patients (32 eyes) with a diagnosis of DON between 2008 and 2019 were included. Our goal was to identify potential pathological signs in patients with DON prior to the definitive diagnosis of DON.ResultsWe discovered that the earliest pathological sign in the subclinical cases was tritan deficiency obtained with a standardised colour vision test by Arden. In all cases but one, regardless of the visual field (VF) defects, the tritan values were pathological (based on a threshold of ≥8%) in the subclinical phase. The mean tritan value was 19.12% (range 6.9–80.8%) at the time of the subclinical phase and 32.16% (range 6.3–100.0%) at the time of the diagnosis of DON. The sensitivity of the colour vision test was 20% for protan and 96.67% for tritan in the subclinical phase. At the time of the definitive diagnosis of DON, the sensitivity of protan was 48.15% compared to 96.30% for tritan.ConclusionWe found that changes in vision affecting the blue-yellow (tritan) colours resulting from the compression of optic nerve, even in affected patients with normal VF tests, are a reliable early sign of DON.

Using frequency-doubling perimetry to detect optic neuropathy in patients with Graves’ orbitopathy

2008 ◽  
Vol 52 (6) ◽  
pp. 475-482 ◽  
Author(s):  
Mário L. R. Monteiro ◽  
André L. F. Portes ◽  
Frederico C. Moura ◽  
Dina B. W. Regensteiner
Keyword(s):  
Optic Neuropathy ◽  
Frequency Doubling ◽  
Graves Orbitopathy ◽  
Frequency Doubling Perimetry

Retinal nerve fiber layer and ganglion cell complex thickness as a diagnostic tool in early stage dysthyroid optic neuropathy

2021 ◽  
pp. 112067212110620
Author(s):  
Lihua Luo ◽  
Dongmei Li ◽  
Lixin Gao ◽  
Wei Wang
Keyword(s):  
Ganglion Cell ◽  
Nerve Fiber ◽  
Layer Thickness ◽  
Optic Neuropathy ◽  
Cell Complex ◽  
Ganglion Cell Complex ◽  
Fiber Layer ◽  
Dysthyroid Optic Neuropathy ◽  
Nerve Fiber Layer ◽  
Nerve Fiber Layer Thickness

Purpose To compare the diagnostic accuracy of peripapillary retinal nerve fiber layer with macular ganglion cell complex thickness as an auxiliary tool for the early diagnosis of dysthyroid optic neuropathy and help assess the effectiveness of the treatment. Methods In this retrospective case–control study, a total of 58 thyroid-associated opthalmopathy patients and 58 healthy participants were enrolled in the study. Thyroid-associated opthalmopathy patients were divided according to the European Group Graves’ Orbitopathy severity classification. The thicknesses of peripapillary nerve fiber layer and macular ganglion cell complex were measured using optical coherence tomography and their correlation with the severity of the disease as well as the effect of the treatment was investigated. Results No statistically significant differences were found between the mild thyroid-associated opthalmopathy group and the control group in both peripapillary nerve fiber layer and macular ganglion cell complex thickness. In the moderate-to-severe thyroid-associated opthalmopathy group, however, Temporal and Nasal peripapillary nerve fiber layer thicknesses were lower compared to the control group ( p = 0.041, p = 0.012), whereas in the sight-threatening thyroid-associated opthalmopathy group Temporal Inferior, Nasal Superior, and mean (G) peripapillary nerve fiber layer thicknesses were larger ( p = 0.000, p = 0.004, p = 0.000). No significant differences were observed in the macular ganglion cell complex thickness among the different severity groups and the control groups ( p > 0.05). After treatment, the mean peripapillary nerve fiber layer thickness decreased whereas mean macular ganglion cell complex thickness showed no significant change in the sight-threatening group. A correlation was established between exophthalmos, best corrected visual acuity, clinical activity score, disease course, and the mean peripapillary nerve fiber layer thickness. The area under curve analysis indicated that mean peripapillary nerve fiber layer thickness can be used as a powerful diagnostic tool in early stage dysthyroid optic neuropathy in thyroid-associated opthalmopathy patients. Conclusion Our study indicates that peripapillary nerve fiber layer act as an auxiliary tool for the early diagnosis of dysthyroid optic neuropathy and helps assess the effectiveness of the treatment.

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