Retinal nerve fiber layer thickness measured by optical coherence tomography predicts visual recovery after orbital decompression for dysthyroid optic neuropathy

Cheng, Shengnan; Yu, Yueqi; You, Ya-Yan; Chen, Jin; Pi, Xiaohuan; Wang, Xinghua; Jiang, Fagang

doi:10.1007/s10792-021-01877-z

Cited by 12 publications

(15 citation statements)

References 35 publications

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“…Thinning of the peripapillary RNFL measured with OCT reflects atrophy of ganglion cells in optic neuropathy 27 . The current results showed more significant RNFL thinning in patients with DON than in patients with non‐DON, consistent with retrograde TSD pathologic changes 28 related to thinning of the RNFL and with previous findings 16,29,30 . Moreover, the thickness of the RNFL correlated with the DTI metrics of the optic nerve and optic tracts.…”

Section: Discussionsupporting

confidence: 87%

“…27 The current results showed more significant RNFL thinning in patients with DON than in patients with non-DON, consistent with retrograde TSD pathologic changes 28 related to thinning of the RNFL and with previous findings. 16,29,30 Moreover, the thickness of the RNFL correlated with the DTI metrics of the optic nerve and optic tracts. These results support the presence of a retrograde TSD; that is, the damage of the optic nerve in DON caused the atrophy of ganglion cells.…”

Section: Discussionmentioning

confidence: 88%

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Preliminary Diffusion‐Tensor Imaging Evidence for Trans‐Synaptic Axonal Degeneration in Dysthyroid Optic Neuropathy Due to Thyroid‐Associated Ophthalmopathy

Liu

Luo

Chen

et al. 2022

Magnetic Resonance Imaging

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BackgroundThe mechanism driving dysthyroid optic neuropathy (DON) is unclear. Diffusion‐tensor imaging (DTI) allows for noninvasively assessing the microstructure of the entire visual pathway and may facilitate a better understanding of the mechanism of DON.PurposeTo assess microstructural changes of the whole visual pathway and to investigate the potential mechanism of trans‐synaptic damage（TSD） pathogenesis in DON with DTI.Study TypeCross‐sectional.PopulationSixty‐four patients with bilateral thyroid‐associated ophthalmopathy (TAO), 30 with and 34 without DON, and 30 age‐ and sex‐matched healthy controls (HCs).Field Strength/Sequence3 T/DTI (A single‐shot diffusion‐weighted echo‐planar imaging sequence).AssessmentDifferences in DTI parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in each segment (optic nerve, tract, and radiation) of the entire visual pathway among the groups were compared. The parameters of visual evoked potentials (VEPs), visual field tests, and mean retinal nerve fiber layer (mRNFL) thickness on optical coherence tomography were also compared across patients.Statistical TestsStudent's t‐test, chi‐square test; ANOVA with post‐hoc testing, interclass correlation coefficient, and correlation analysis. Significance level: P < 0.05.ResultsTAO patients with DON showed significantly reduced mRNFL thickness and abnormal VEPs. There was a tendency for gradually reduced FA and AD, and increased RD and MD from HCs, with non‐DON to with DON in optic nerve and tract, statistically. For radiation, the RD and MD showed statistical increase, the AD and FA just showed numerical decrease (P = 0.119 and 0.059, respectively). For DON, the FA and MD of visual pathway segments showed correlations with abnormal VEPs.Data ConclusionDTI may be a useful tool for detecting microstructural changes in the entire visual pathway in DON. The changes in RNFL thickness and DTI parameters suggested TSD as a potential pathogenic mechanism of DON.Evidence Level: 4Technical Efficacy: Stage 5

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 88%

Preliminary Diffusion‐Tensor Imaging Evidence for Trans‐Synaptic Axonal Degeneration in Dysthyroid Optic Neuropathy Due to Thyroid‐Associated Ophthalmopathy

Liu

Luo

Chen

et al. 2022

Magnetic Resonance Imaging

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“…The classic theory is that retinal edema occurs when the retina is de cient in blood supply and hypoxia, which may be the reason for the thickening of the RNFL. These are also consistent with other experimental results 21 and need to be further explored.…”

Section: Discussionsupporting

confidence: 91%

Surgical Outcomes of Standardized Endoscopical Deep Medial Orbital Decompression in Dysthyroid Optic Neuropathy

Gao

Zhang

et al. 2023

Preprint

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Objectives: To standardize the endoscopic deep medial orbital decompression surgery for better relief of optic nerve compression in dysthyroid optic neuropathy (DON). Methods: A total of 128 eyes from patients received the standardized endoscopic deep medial orbital decompression surgery were recruited in this study. The efficacy of the procedure was assessed at a one-month follow-up by the best-corrected visual acuity (VA), visual field (VF), and visual evoked potential (VEP). Clinical data were collected to explore the factors that affected visual recovery. Oxygen saturation of retinal blood vessels, retinal thickness, and vessel density were measured to demonstrate the potential recovery mechanisms. Results: After surgery, the ratio of extraocular muscle volume in the orbital apex to orbital apex volume significantly decreased from 44.32 ± 22.31% to 36.82 ± 12.02% (P < 0.001). 96.87% of eyes’ final VA improved, average VA improved from 0.93 ± 0.73 to 0.50 ± 0.60 at 1 week (P < 0.001) and 0.40 ± 0.53 at 1 month (P < 0.001). Postoperatively VF and VEP also improved, the oxygen saturation of retinal arteries increased, and the retinal thickness was reduced. Preoperative VA, visual impairment duration, and clinical activity score evaluation were associated with visual recovery. Conclusions: In this study, we standardized the endoscopic deep medial orbital decompression, of which key point was to relieve pressure in the orbital apex and achieved satisfactory visual recovery in DON patients.

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“…Therefore, the postoperative RNFL loss in the surgical TED group may be mainly attributed to the surgical traction to the optic nerve and its supplying blood vessels and the compression from postoperative tissue swelling. The resolving disc edema and chronic optic nerve atrophy may explain that the DON group had more RNFL loss [ 13 , 14 ]. However, the role of resolving disc edema is less critical in our cohort since we excluded cases with disc swelling.…”

Section: Discussionmentioning

confidence: 99%

“…The thickness of the retinal nerve fiber layer (RNFL) decreased after orbital decompression surgery in eyes with TED and DON. This could be attributed to the mixture of resolved disc swelling and chronic optic nerve atrophy [ 13 , 14 ]. However, no study had investigated the RNFL changes in TED eyes without DON.…”

Section: Introductionmentioning

confidence: 99%

The Changes in Optic Nerve after Orbital Decompression Surgery for Thyroid Eye Disease and Case Reports of Ischemic Optic Neuropathy

Hsia

Hsiao

Wei

et al. 2022

BioMed Research International

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Purpose. To demonstrate the changes in the retinal nerve fiber layer (RNFL) after orbital decompression for thyroid eye disease (TED). Methods. We retrospectively enrolled 52 surgical TED patients, 30 nonsurgical TED patients, and 30 control subjects. Five surgical TED eyes with disc edema were excluded. The surgical TED patients were classified into the “dysthyroid optic neuropathy (DON)” group (16 eyes) and the “non-DON” group (83 eyes). Optical coherence tomography (OCT) and visual field (VF) examinations were performed preoperatively and 6 months later. The control subjects and nonsurgical TED patients received two OCT examinations at 6-month intervals. The postoperative changes in the RNFL thickness were compared between groups. Three cases with severe postoperative vision loss were presented additionally. Results. The changes in the RNFL thickness of the controls ( 0.5 ± 3.4 μ m ) and the nonsurgical TED patients ( 0.3 ± 2.8 μ m ) were significantly smaller than the surgical TED patients ( P < 0.001 ). The DON group ( − 9.2 ± 9.2 μ m ) had greater RNFL thickness reduction than the non-DON group ( − 3.9 ± 5.4 μ m ) ( P = 0.002 ). Bone removal decompression was associated with decreased RNFL in the non-DON ( P = 0.025 ; β = − 2.49 ) and DON ( P = 0.042 ; β = − 9.43 ) groups. Three cases who were hard to operate due to extensive fibrosis experienced severe vision loss postoperatively due to anterior ischemic optic neuropathy, posterior ischemic optic neuropathy, and posterior ciliary artery occlusion, respectively. Conclusions. TED patients experienced subclinical optic nerve injury and significant RNFL loss after the orbital decompression surgery. Aggressive manipulation during decompression surgery may lead to dreadful vision loss. Tailored surgical plans and delicate manipulation are warranted.

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Retinal nerve fiber layer thickness measured by optical coherence tomography predicts visual recovery after orbital decompression for dysthyroid optic neuropathy

Cited by 12 publications

References 35 publications

Preliminary Diffusion‐Tensor Imaging Evidence for Trans‐Synaptic Axonal Degeneration in Dysthyroid Optic Neuropathy Due to Thyroid‐Associated Ophthalmopathy

Preliminary Diffusion‐Tensor Imaging Evidence for Trans‐Synaptic Axonal Degeneration in Dysthyroid Optic Neuropathy Due to Thyroid‐Associated Ophthalmopathy

Surgical Outcomes of Standardized Endoscopical Deep Medial Orbital Decompression in Dysthyroid Optic Neuropathy

The Changes in Optic Nerve after Orbital Decompression Surgery for Thyroid Eye Disease and Case Reports of Ischemic Optic Neuropathy

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