ETA2023 45th Annual Meeting of the European Thyroid Association ETA 2023 Oral Session 9: Thyroid Eye Disease (5 abstracts)
Clinical and visual outcomes of dysthyroid optic neuropathy after surgical orbital decompression
Mirco Armenti 1 , Nicola Currò 2 , Claudio Guastella 3 , Alessandra Bottari De Castello 2 , Maria Chiara Fazio 2 , Andrea Contarino 4 , Giada Rossi 4 , Ilaria Muller 5 , Maura Arosio 5 , Francesco Viola 2 , Lorenzo Pignataro 3 & Mario Salvi 6
1Graves Orbitopathy Center, Fondazione Irccs Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Endocrinology, Milan, Italy; 2Unit of Ophthalmology, Department of Surgery, Fondazione, Irccs Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy.; 3Unit of Otolaryngology, Department of Surgery, Fondazione, Irccs Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy.; 4Graves Orbitopathy Center, Fondazione Irccs Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; 5Graves Orbitopathy Center, Fondazione Irccs Cà Granda, Ospedale Maggiore Policlinico, Endocrinology, Fondazione Irccs Cà Granda, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan; 6Graves Orbitopathy Center, Fondazione Irccs Cà Granda, Ospedale Maggiore Policlinico, Unit of Endocrinology, Department of Clinical Sciences and Community Health, Fondazione, Irccs Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Objectives: Dysthyroid Optic Neuropathy (DON) is a severe complication of Graves’ Orbitopathy (GO), requiring prompt treatment. First line treatment is high dose intravenous steroids, then surgery is considered mandatory. We studied the clinical outcomes of surgery for DON, with and without previous therapy with steroids.
Methods: 88 orbits of 56 patients with DON were treated with surgical orbital decompression. 33 orbits (37.5 %) underwent surgery as first line treatment, while 55 (62.5%) after unresponsiveness to high dose steroids. We studied, before and after surgery (1 week, 1, 3, 6, 12 months), pinhole best corrected visual acuity (p-BCVA), colour sensitivity, automated visual field, pupil reflexes, optic disc and fundus appearance, exophtalmometry and ocular motility. Clinical activity score (CAS) was used to grade GO activity. Exclusion criteria were previous orbital surgery, concurrent neurological or ophthalmologic diseases, incomplete follow-up. Surgery was considered successful if no other intervention was needed to preserve visual function.
Results: Surgery was successful in 77 orbits (87.5%). The remaining 11 orbits (12.5%) needed further intervention. Overall, all parameters of visual function (except for diplopia) improved significantly at follow-up (P < 0.05) and GO inactivated (CAS<3) within one month. At three months (primary endpoint), all 77 responding orbits had p-BCVA > 0.63 and the 11 unresponsive orbits had p-BCVA ≤ 0.63. At follow-up, visual field parameters and colour sensitivity showed no correlation with responsiveness. At primary endpoint, the ROC curve analysis applied to p-BCVA (decimal notation) resulted in an AUC of 0.993 (95% CI 0.978–1.000; P < 0.0001) with a cut off of > 0.63 (100 % sensitivity and 88.9 % specificity). Therapy with high dose steroids before surgery was associated to a better response rate (96% vs.73%; P < 0.005) and to a higher final p-BCVA (0.89±0.11 vs. 0.82±0.20, P < 0.05). Balanced wall decompression resulted in a better response compared to only medial wall decompression (96% vs. 80%; P < 0.05). Significant inverse correlation was found between final BCVA and patient’s age (r = -0.42; P < 0.0005). Unresponsive orbits had worse p-BCVA (P < 0.001) and higher proptosis (P < 0.005) at baseline.
Conclusions: Surgical decompression is an excellent treatment for DON. After surgery, all but one parameter (diplopia) improved. P-BCVA > 0.63 at three months was highly associated to a successful response. We also observed that steroids administered before surgery seem to maximize its efficacy. The time between 1 and 3 months after surgery appears to be very important to identify those orbits that need additional surgery to treat DON.
Volume 92
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