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Predicting visual acuity recovery in orbital decompression surgery for dysthyroid optic neuropathy
Forrest W Fearington1, Lazaro R Peraza2, Gabriel A Hernandez-Herrera2
1Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
Thyroid Research
|June 30, 2025
Summary
Preoperative best corrected visual acuity (BCVA) is the strongest predictor of outcomes following surgery for dysthyroid optic neuropathy (DON). Early intervention before significant vision loss improves the chances of successful recovery.
Area of Science:
- Ophthalmology
- Endocrinology
Background:
- Thyroid eye disease can lead to dysthyroid optic neuropathy (DON).
- Orbital decompression surgery is a common treatment for DON.
- Predicting postoperative visual acuity is crucial for managing DON patients.
Purpose of the Study:
- To identify preoperative factors predicting postoperative best corrected visual acuity (BCVA) in DON patients.
- To classify DON recovery rates based on prognostic factors.
Main Methods:
- Retrospective assessment of 32 patients (51 orbits) with DON undergoing orbital decompression.
- Univariate and multivariate mixed effects analysis to identify predictors of postoperative BCVA.
Main Results:
- Preoperative BCVA was the strongest predictor of postoperative BCVA (p < 0.0001).
- Other significant factors included extraocular muscle hypertrophy, visual field mean deviation, retinal nerve fiber layer thickness, and afferent pupillary defect.
- Patients with preoperative BCVA > logMAR 0.60 (20/80 Snellen) had a <30% chance of acceptable vision recovery, versus >80% for those with preoperative BCVA < logMAR 0.60.
Conclusions:
- Preoperative BCVA is the most significant predictor of DON treatment outcomes.
- Earlier surgical intervention before substantial BCVA decline is recommended for better results.
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