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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
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[Dysthyroid optic neuropathy: surgical treatment potential]
Y O Grusha1,2, D S Ismailova1, P A Kochetkov2
1Research Institute of Eye Diseases, Moscow, Russia.
Vestnik Oftalmologii
|September 4, 2020
Summary
Bony orbital decompression effectively treats dysthyroid optic neuropathy (DON) when other treatments fail. This surgery safely improves vision and reduces eye protrusion in patients with thyroid eye disease (TED).
Area of Science:
- Ophthalmology
- Endocrinology
- Neurosurgery
Background:
- Dysthyroid optic neuropathy (DON) is a severe complication of thyroid eye disease (TED).
- DON can lead to significant vision loss and is often resistant to medical management, including high-dose glucocorticoids.
- Surgical intervention, such as bony orbital decompression, is considered when conservative treatments are ineffective.
Purpose of the Study:
- To evaluate the efficacy and safety of bony orbital decompression for patients diagnosed with dysthyroid optic neuropathy (DON).
- To assess the impact of bony orbital decompression on visual acuity, visual fields, and exophthalmos in DON patients.
Main Methods:
- Retrospective analysis of 255 patients with thyroid eye disease (TED) who underwent bony orbital decompression.
- Detailed ophthalmological examinations, including visual acuity, computer perimetry, color vision testing, and relative afferent pupillary defect (RAPD) assessment.
- Pre- and post-operative orbital computed tomography (CT) and optical coherence tomography (OCT) were utilized to evaluate structural changes and optic nerve status.
Main Results:
- The study included 31 patients (52 eyes) with DON requiring surgery.
- Various decompression techniques (lateral wall, medial wall, simultaneous, or sequential) were employed.
- Postoperatively, all patients demonstrated significant improvements in visual acuity, visual fields, and a reduction in exophthalmos (average decrease of 4.7 mm).
- Orbital inflammation also decreased significantly in all cases, with statistically significant results (p<0.01).
Conclusions:
- Bony orbital decompression is a highly effective and safe treatment for dysthyroid optic neuropathy (DON) refractory to high-dose glucocorticoids.
- This surgical approach is often the sole method for improving and stabilizing visual function in severe DON cases.
- The procedure offers significant benefits in visual recovery and reduction of proptosis for patients with TED-related optic neuropathy.
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