Quantitative Computed Tomographic Predictors of Compressive Optic Neuropathy in Patients with Thyroid Orbitopathy

Weis, Ezekiel; Heran, Manraj K.S.; Jhamb, Ashu; Chan, Andy K.; Chiu, Jack P.; Hurley, Michael C.; Rootman, Jack

doi:10.1016/j.ophtha.2012.04.021

Cited by 72 publications

(50 citation statements)

References 8 publications

(7 reference statements)

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“…They found that medial rectus muscle size was a predictor of compressive optic neuropathy. 30 As compression on the optic nerve is also related with the stasis in the choroid, we hypothesize that increase in extra-ocular volume might also be related with the increase in choroidal thickness. In our study, none of the patients had the clinical signs of optic neuropathy.…”

Section: Eyementioning

confidence: 94%

Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy

Özkan

Koçer

Altıntaş

et al. 2016

Eye

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Section: Eyementioning

confidence: 94%

Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy

Özkan

Koçer

Altıntaş

et al. 2016

Eye

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“…Here, the medial rectus is most proximal to the optic nerve and compression from EOM swelling can cause optic nerve ischemia or inhibit axonal flow. The medial rectus volume, which can be approximated by medial rectus axial diameter, seems to be the strongest predictor of DON[26]. Orbital computed tomography (CT) studies demonstrate significant optic nerve crowding at the orbital apex in the vast majority of patients with DON, and may also demonstrate intracranial fat prolapse or an increased superior ophthalmic vein diameter[1,23,27,28].…”

Section: Pathophysiologymentioning

confidence: 99%

Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management

Blandford

Zhang

Chundury

et al. 2017

Expert Review of Ophthalmology

100

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Introduction Dysthyroid optic neuropathy (DON) is a severe manifestation of thyroid eye disease (TED) that can result in permanent vision loss. Management is complex, multidisciplinary, and involves medical and/or surgical therapies. This review describes current concepts in the epidemiology, pathophysiology, diagnosis, and treatment of DON. Areas covered An extensive review of the literature was performed to detail current concepts on the diagnosis and management of DON. This includes utilization of various medical and surgical modalities for disease management. Expert commentary DON can result in permanent blindness and often requires the use of corticosteroids and surgical decompression. We favor the use of intravenous corticosteroids and a transcaruncular approach when surgical decompression is indicated. The use of orbital radiation for DON is often reserved for patients that are poor surgical candidates and/or patients with refractory disease.

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“…Both axial and coronal images are useful [4]. CT has proven to be excellent in identifying orbital pathology and in visualizing the degree of extraocular muscle and orbital fat enlargement [7–9], and it is often the preferred imaging technique for investigating DON [5]. Some patients with GO have enlarged muscles (muscle GO), some have increased orbital fat (fat GO), and others have both enlarged muscles and increased orbital fat [4].…”

Section: Introductionmentioning

confidence: 99%

Orbital Volumetry in Graves' Orbitopathy: Muscle and Fat Involvement in relation to Dysthyroid Optic Neuropathy

et al. 2014

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Purpose. We wanted to investigate the relative significance of fat and muscle enlargement in the development of dysthyroid optic neuropathy (DON) in Graves' orbitopathy (GO). Methods. Preoperative coronal CT scans of 13 patients with and without DON who subsequently underwent orbital decompression were retrospectively analyzed. Thirteen patients imaged for unilateral orbital fractures served as controls. Results. The retrobulbar muscle volume was 2.1 ± 0.5 cm3 (mean ± SD) in controls, 4.3 ± 1.5 cm3 in GO without DON, and 4.7 ± 1.7 cm3 in GO with DON. The retrobulbar fat volume was 5.4 ± 1.6 cm3 in controls, 8.7 ± 8.0 cm3 in GO without DON, and 9.4 ± 3.1 cm3 in GO with DON. The muscle and fat volumes were higher in patients with GO than in controls (P < 0.001), but the volumes in orbits with and without DON were not significantly different. The volume of the optic nerve were similar in the 3 groups. The number of apical, coronal 2 mm thick slices with no fat was 2.9 ± 0.9 in normal orbits, it was 4.1 ± 1.0 in GO orbits without DON and 5.3 ± 0.8 in GO orbits with DON (P = 0.007). Conclusion. Apical muscle enlargement may be more important than orbital fat enlargement in the development of DON. However, the fact that apical crowding and muscle enlargement also occur in orbits without DON suggests that other factors also play a role in the development of DON.

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Quantitative Computed Tomographic Predictors of Compressive Optic Neuropathy in Patients with Thyroid Orbitopathy

Cited by 72 publications

References 8 publications

Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy

Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy

Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management

Orbital Volumetry in Graves' Orbitopathy: Muscle and Fat Involvement in relation to Dysthyroid Optic Neuropathy

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