A British Ophthalmological Surveillance Unit (BOSU) study into dysthyroid optic neuropathy in the United Kingdom

Wong, Yun; Dickinson, Jane; Perros, Petros; Dayan, Colin; Veeramani, P.; Morris, Daniel S.; Foot, B; Clarke, Lucy

doi:10.1038/s41433-018-0144-x

Cited by 27 publications

(32 citation statements)

References 23 publications

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“… 8 Despite the widespread use of these modalities over decades for TED, the literature is mostly comprised of retrospective studies, Case reports and small case series which now guide practice patterns in the treatment of DON. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 There has only been one prospective, randomized controlled trial (RCT) to compare corticosteroids versus corticosteroids and surgical decompression for DON. 12 In this study, Wakelkamp et al reported similar initial outcomes after medical decompression and surgical decompression, and found that immediate surgical decompression did not result in better visual outcomes nor did it preclude the use of corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: A multicenter study

Sears

Wang

Bailey

et al. 2021

American Journal of Ophthalmology Case Reports

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Purpose To study post-interventional findings in patients with dysthyroid optic neuropathy (DON) treated with teprotumumab. Observations In this multicenter observational Case series , patients with DON were treated with teprotumumab, an insulin-like growth factor I receptor inhibitor (10 mg/kg for the first infusion then 20 mg/kg for subsequent infusions, every three weeks for a total 8 infusions). This study included patients with acute and chronic thyroid eye disease (TED) with DON who had failed conventional therapies and were not candidates for surgical decompression. Data collected included best corrected visual acuity (BCVA), color vision, RAPD when present, and orbital CT or MRI. Proptosis, clinical activity score (CAS), Gorman diplopia score (GDS), and Humphrey visual fields (HVF) were also evaluated. Ten patients (6 women, 4 men) with an average age 64 years old were included in this study. Mean follow up after completion of infusions was 15 weeks. Baseline visual acuity (VA) impairment ranged from hand motion (HM) to 20/25 in affected eyes. All patients had pre-treatment orbital CT or MRI that confirmed orbital apex compression. Seventy percent of patients had objective improvement in DON after 2 infusions of teprotumumab measured as significant improvement in visual acuity, resolution of RAPD, or both. After completion of treatment, affected eyes had a mean BCVA improvement of 0.87 logMAR (p=0.0207), proptosis reduction of 4.7 mm (p<0.00001), CAS improvement of 5.25 points (p<0.00001), and GDS improvement of 0.75 points (p=0.160). All 6 patients who presented with an RAPD had resolution or improvement of RAPD. All 7 patients who presented with color vision deficits had normalization or improvement of color vision. Conclusions and Importance Teprotumumab infusions resulted in medical decompression and objective resolution or improvement of dysthyroid optic neuropathy. Most patients had rapid improvement of visual acuity and reversal of RAPD. Post-infusion imaging demonstrated reduction in extraocular muscle size that correlated with improvement in visual dysfunction. However, patients who presented with longstanding severe visual loss had limited improvement. There was no recurrence of DON after completion of teprotumumab in our cohort.

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Section: Discussionmentioning

confidence: 99%

Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: A multicenter study

Sears

Wang

Bailey

et al. 2021

American Journal of Ophthalmology Case Reports

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“…Previous studies have suggested that MPT appears to be the first choice for active TAO with DON rather than immediate surgery, while a complete recovery can be achieved in the majority of patients with DON by combination therapy [15][16][17][18]. Numerous researches have investigated the clinical manifestations, diagnosis, and treatment of TAO so far, but researches on the benefits and timing of decompression surgery and MPTfor DON patients are deficient [17,[19][20][21]. is study investigated and compared the effect of combined treatment of orbital decompression and MPT on one eye of patients with bilateral DON, and the effect of separate MPT on the fellow eye of the same patients.…”

Section: Discussionmentioning

confidence: 99%

The Therapeutic Effect of Combination of Orbital Decompression Surgery and Methylprednisolone Pulse Therapy on Patients with Bilateral Dysthyroid Optic Neuropathy

Guo

et al. 2020

Journal of Ophthalmology

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Purpose. To investigate the synergic effect of combination of orbital decompression surgery and methylprednisolone pulse therapy (MPT) and MPT alone on the visual function in patients with bilateral dysthyroid optic neuropathy (DON). Methods. For each involved patient with bilateral DON, only one eye was treated with orbital decompression surgery which was conducted by the same doctor, and each of them received MPT after surgery. If the visual function deteriorated despite treatment, patients would switch to the other treatment. All the patients were followed up for 3 months after surgery. Clinical features of patients including best corrected visual acuity (BCVA), intraocular pressure (IOP), proptosis, upper eyelid retraction, and clinical activity score (CAS) before and after surgery were analyzed, respectively. Visual field and visual evoked potential (VEP) tests were also performed. Paired t-test and Wilcoxon matched-pairs signed ranks sum test were used to analyze the data. Result. A prospective cohort of 23 patients with bilateral DON was enrolled in this cohort study. No patients failed to the therapy or switched to another treatment. The quantitative variables were shown as means and standard deviations (SD). After 3 months of combined treatment of orbital decompression surgery and MPT, BCVA (logMAR) improved, proptosis was reduced and the upper eyelid retraction was relieved in both eyes of patients; however, these improvements were more significant in the operated eyes than in the fellow (nonoperated) eyes. IOP decreased significantly in the operated eyes (P=0.002), while having no significant change in the nonoperated eyes (P=0.993). CAS reduced by 0.8 ± 1.37 in the operated eyes and by 0.9 ± 1.28 in the nonoperated eyes (P=0.011, P=0.005, respectively), but its reduction extent showed no significant difference between the operated and fellow eyes (P=0.771). Visual field tests showed the mean deviation (MD) of the operated and fellow eyes both increased significantly after 3 months of treatment (P<0.001, P=0.001, respectively). MD of the operated eyes increased by 8.1 ± 7.72 dB, which was more significant than that of the fellow eyes which increased by 3.4 ± 5.02 dB (P=0.005). The VEP test showed that, in the operated eyes, the latency of each spatial frequency of P100 was significantly shortened (P<0.05, respectively), and the amplitude was significantly improved (P<0.05, respectively); however, there was no significant change in VEP parameters of the fellow eyes (P>0.05, respectively). The latency in the operated eyes improved by 28.1 ± 29.93 ms in 60′ P100, by 40.2 ± 32.87 ms in 30′ P100, and by 20.7 ± 25.87 ms in 15′ P100 respectively, which was more excellent in the degree of the improvement than that in the fellow eyes (P=0.002, P=0.001, P=0.005, respectively). Conclusion. A combination of orbital decompression and MPT can significantly improve visual function in patients with DON, reduce intraocular pressure, and relieve clinical symptoms such as upper eyelid retraction and proptosis, while MPT alone has a limited effect. For DON patients, orbital decompression should be performed promptly to improve the visual function.

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“…TED with DON is mainly a result of crowding around the orbital apex with nerve compression secondary to expanded extraocular muscles [ 14 ] or some caused by optic nerve stretching without a crowded apex [ 15 ]. In a British study of 71 eyes of 49 patients with DON, most patients received initial corticosteroid therapy yet almost 50% required surgical orbital decompression [ 16 ]. A large American study of 163 eyes of 104 patients with DON received combined corticosteroid and orbital radiotherapy has reported that among the initially 95% successfully treated patients, ultimately 36.7% of them underwent elective surgery, including orbital decompression during the inactive phase of TED [ 17 ].…”

Section: Principle Of Don Treatmentmentioning

confidence: 99%

Strategies in Surgical Decompression for Thyroid Eye Disease

Cheng

Wei

Liao

2020

Oxidative Medicine and Cellular Longevity

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Surgical management of thyroid eye disease- (TED-) associated morbidity has been plagued by the complex interplay of different operative techniques. Orbital decompression is the well-recognized procedure for disfiguring exophthalmos and dysthyroid optic neuropathy (DON). There are numerous published techniques described for the removal of the orbital bone, fat, or a combination. The diverse studies are noncomparative as they include different indications, stages of disease, and methods of evaluation. Thus, it is difficult to conclude the most efficient decompression technique. To obtain effective and predictable results, it is therefore important to propose a logical and acceptable clinical guideline to customize patient treatment. Herein, we developed an algorithm based on the presence of DON, preoperative existing diplopia, and severity of proptosis which were defined by patient’s disabling symptoms together with a set of ocular signs reflecting visual function or cosmesis. More specifically, we aimed to assess the minimal but effective surgical technique with acceptable potential complications to achieve therapeutic efficacy. Transcaruncular or inferomedial decompressions are indicated in restoring optic nerve function in patients with DON associated with mild or moderate to severe proptosis, respectively. Inferomedial or fatty decompressions are effective to treat patients with existing diplopia associated with mild or moderate to severe proptosis, respectively. Fatty or balanced decompressions can improve disfiguring exophthalmos in patients without existing diplopia associated with mild to moderate or severe proptosis, respectively. Inferomedial or 3-wall decompressions are preferred to address facial rehabilitation in patients associated with very severe proptosis but without preoperative diplopia.

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A British Ophthalmological Surveillance Unit (BOSU) study into dysthyroid optic neuropathy in the United Kingdom

Cited by 27 publications

References 23 publications

Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: A multicenter study

Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: A multicenter study

The Therapeutic Effect of Combination of Orbital Decompression Surgery and Methylprednisolone Pulse Therapy on Patients with Bilateral Dysthyroid Optic Neuropathy

Strategies in Surgical Decompression for Thyroid Eye Disease

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