Abstract

DO.19.03

Dysthyroid optic neuropathy: therapeutic review after orbital decompression

Fichter N., Vorlaender S., Schittkowski M., Guthoff R. F.
Universitäts-Augenklinik Rostock

Objective: Dysthyroid optic neuropathy (DON) requires immediate therapeutic intervention independent of the activity of the underlying disease. The aim of this study was to evaluate the therapeutic outcome after decompression of the medial and/or lateral wall.
Methods: From 2001 to 2007 35 patients with DON underwent orbital decompression by a lateral and or medial approach. In those patients without or with only slight impairment of visual acuity DON was supported by additional examinations like visual fields, RAPD, visual evoked responses etc.
In 18 patients (26 orbits) with incipient DON and without thickening of the extraocular muscles (EOM) in the orbital apex decompression was performed by a lateral approach. Compression of the optic nerve in the orbital apex by EOM required medial wall decompression in 7 patients (14 orbits) and a combined medial and lateral wall approach in 10 patients (12 orbits). Pre- and postoperative data were evaluated retrospectively concerning visual acuity, pupillary reflex (RAPD), colour vision, visual fields and visual evoked responses.
Results: After lateral wall decompression visual acuity improved in average about 0,1 lines (preoperative 0,8, postoperative 0,9) compared to 0,3 after medial wall decompression (preoperative 0,4, postoperative 0,7) and 0,2 after the two-wall-approach (preoperative 0,2, postoperative 0,4). Furthermore there was a rapid an significant improvement of the preoperative pathologic findings in the additionally performed examinations.
Conclusions: Bony orbital decompression leads to an efficient decompression in case of DON. Since visual acuity is often normal in case of incipient DON routinely examinations should include examination of pupillary reflex (RAPD), colour vision, visual fields and visual evoked responses.

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