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. 2021 Apr 28;8(1):19.
doi: 10.1186/s40662-021-00238-2.

Modified endoscopic transnasal orbital apex decompression in dysthyroid optic neuropathy

Yunhai Tu #  1 , Mingna Xu #  1 , Andy D Kim  2 , Michael T M Wang  2 , Zhaoqi Pan  1 , Wencan Wu  3
Affiliations

Modified endoscopic transnasal orbital apex decompression in dysthyroid optic neuropathy

Yunhai Tu et al. Eye Vis (Lond). .

Abstract

Background: To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.

Methods: In this retrospective research, forty-two subjects (74 orbits) who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled. Preoperative and postoperative best-corrected visual acuity (BCVA), visual field mean deviation (MD), Hertel exophthalmometry, and new onset diplopia were assessed before and after the intervention. The Wilcoxon test was used for differential analysis. Linear mixed-models' analyses were conducted to assess the potential predictors for BCVA change.

Results: Postoperatively, the mean BCVA improved from 0.70 ± 0.62 logMAR to 0.22 ± 0.33 logMAR. BCVA significantly improved in 69 eyes (93%), remained stable in 4 eyes (5%) and deteriorated in 1 eye (1%). MD of visual fields improved from -13.73 ± 9.22 dB to -7.23 ± 7.04 dB. Proptosis decreased from 19.57 ± 3.38 mm to 16.35 ± 3.01 mm. Preoperative BCVA, MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA (P < 0.05) by linear mixed-models' analyses. Eighteen patients (42.9%) developed new diplopia postoperatively.

Conclusion: Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.

Keywords: Dysthyroid optic neuropathy; Endoscopic transnasal orbital decompression; Thyroid-associated ophthalmopathy; Visual acuity; Visual field.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Endoscopic transnasal orbital apex decompression was performed in a DON patient. a Before removal of the inferior wall of the left orbital apex (white asterisk). b After removal of the bone at the junction of orbital apex and pterygopalatine fossa (black asterisk). c After decompression of the anterior segment of the optic canal. The orbital periosteum of the orbital apex is incised (black arrow). d Preservation of the inferomedial strut (white asterisk) and creation of periosteal band (black asterisk). IR = inferior rectus, ON = optic nerve
Fig. 2
Fig. 2
Left nostril endoscopic endonasal views. The purple area indicates the extent of modification. The green area indicates the extent of ordinary bone resection.The periosteum was incised along the white dotted line
Fig. 3
Fig. 3
Mean change in best-corrected visual acuity (BCVA) from baseline to postoperative visits 1–4. Five waves of data were collected, including baseline, the follow-up visits occurred in 2 weeks, 1, 3, 6 months, respectively
See this image and copyright information in PMC

References

    1. Blandford AD, Zhang D, Chundury RV, Perry JD. Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management. Expert Rev Ophthalmol. 2017;12(2):111–21. - PMC - PubMed
    1. Currò N, Covelli D, Vannucchi G, Campi I, Pirola G, Simonetta S, et al. Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Thyroid. 2014;24(5):897–905. - PubMed
    1. Bartalena L, Krassas GE, Wiersinga W, Marcocci C, Salvi M, Daumerie C, et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy. J Clin Endocrinol Metab. 2012;97(12):4454–63. - PubMed
    1. Taylor PN, Zhang L, Lee RWJ, Muller I, Ezra DG, Dayan CM, et al. New insights into the pathogenesis and nonsurgical management of Graves orbitopathy. Nat Rev Endocrinol. 2020;16(2):104–16. - PubMed
    1. Tooley AA, Godfrey KJ, Kazim M. Evolution of thyroid eye disease decompression-dysthyroid optic neuropathy. Eye (Lond). 2019;33(2):206–11. - PMC - PubMed

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