Clinical profile and visual outcomes after treatment in patients with dysthyroid optic neuropathy.
Clinical profile and visual outcomes after treatment in patients with dysthyroid optic neuropathy.
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DOI：
10.3341/kjo.2012.26.2.73
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发表时间：
2012-04
影响因子：
--
通讯作者：
Kim YD
中科院分区：
文献类型：
--
作者：
Jeon C;Shin JH;Woo KI;Kim YD
报告甲状腺功能异常性视神经病变（DON）患者的临床资料和治疗后的视力结果。回顾性分析40例（65眼）DON患者的临床资料和眼眶影像学资料，分析其经静脉类固醇冲击治疗、放射治疗和眼眶减压治疗后的视力结果。该研究包括21名男性和19名女性，其中10名（25%）为糖尿病患者。视野检查结果显示，88.7%的DON眼存在缺陷，63.2%的DON眼存在传入瞳孔缺陷，78.5%的DON眼色觉减退，84%的DON眼存在视觉诱发电位异常。眼眶成像显示95%的眼眶出现中度至重度顶端拥挤，24.2%的眼眶出现颅内脂肪脱垂。治疗一年后，中位最佳矫正视力从0.4提高到1.0（p < 0.001）。我们注意到使用减压手术比非手术方法在视力上有更多的改善（p < 0.05）。7例未接受眼眶放疗的患者出现复发。眼眶影像学视野缺损和心尖部拥挤是诊断DON最敏感的指标。静脉类固醇冲击治疗、放射治疗和眼眶减压术有效地改善了DON患者的视力结果。
To report the clinical data and visual outcomes after treatment of patients with dysthyroid optic neuropathy (DON). We retrospectively reviewed the medical records and orbital images of 40 patients (65 eyes) with DON and analyzed the visual outcomes after treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression. The study included 21 men and 19 women, with 10 (25%) being diabetic patients. Visual field test results revealed defects in 88.7% of DON eyes; afferent pupillary defects in 63.2%; reduced color vision in 78.5%; and abnormal visual evoked potentials in 84%. Orbital imaging showed moderate to severe apical crowding in 95% of the orbits and intracranial fat prolapse in 24.2%. Median best corrected visual acuity improved from 0.4 to 1.0 after one year of treatment (p < 0.001). We noted more improvement in vision with the use of decompressive surgery than with non-surgical methods (p < 0.05). Recurrences occurred in 7 patients who had not received orbital radiotherapy. Visual field defects and apical crowding seen on orbital imaging were the most sensitive indicators for the detection of DON. Treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression effectively improved visual outcomes in cases of DON.