Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss

• Published in: Orbit (Amsterdam) Vol. 28; no. 6; pp. 354 - 362
• Main Authors: Mensah, Aurore, Vignal-Clermont, Catherine, Mehanna, Chadi, Morel, Xavier, Galatoire, Olivier, Jacomet, Pierre-Vincent, Morax, Serge
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 01.12.2009; Taylor & Francis
• Subjects: Age of Onset; Altitudinal field defect; Decompression, Surgical; Dysthyroïd optic neuropathy; Evoked Potentials, Visual; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Graves Ophthalmopathy - complications; Graves Ophthalmopathy - diagnosis; Graves Ophthalmopathy - therapy; Graves' orbitopathy; Humans; Male; Methylprednisolone - administration & dosage; Middle Aged; Optic Nerve Diseases - diagnosis; Optic Nerve Diseases - etiology; Optic Nerve Diseases - therapy; Prognosis; Prognostic; Retrospective Studies; Risk Factors; Steroid treatment; Vision Disorders - diagnosis; Vision Disorders - etiology; Vision Disorders - therapy; Visual Acuity - physiology
• ISSN: 0167-6830; 1744-5108
• DOI: 10.3109/01676830903104728

Purpose: Dysthyroid Optic Neuropathy (DON) can lead to irreversible visual loss. We report risk features correlated with poor visual recovery despite an intensive treatment in a series of patients with DON. Design: Retrospective analysis of a non-comparative interventional series. Methods: Between 1997 and 2007, 300 consecutive patients with Graves' orbitopathy were seen at the Rothschild Foundation (Paris). Medical records of all consecutive patients who developed a DON were reviewed. Demographic, clinical features and visual function were collected at the time of the first onset, one month follow-up after medical and sometime surgical treatment and at the last examination. Statistical analysis (reflected as p values) gathered the significant observations into detrimental visual recovery prognostic factors for DON. Results: Fifty-six eyes of 29 patients developed a DON. Sixteen eyes (28%) did not improve vision despite usual treatment (intravenous steroids and surgical decompression when necessary). An inferior altitudinal visual field defect (AVF, p=0,0004) and/or a lack of response to intravenous steroids boluses (p= 0,011) were related to a poor recovery. Conclusion: DON prognosis is highly variable. Our results suggest that a non-inflammatory element, probably vascular could be involved in atypical DONs. An earlier recognition could prompt to rapid surgical treatment for these patients.