The Visual Function of Emergent Transnasal Endoscopic Orbital Decompression Surgery for Patients With...

Dysthyroid optic neuropathy (DON) is occasionally resistant to corticosteroid treatment. In these cases, emergent transnasal endoscopic orbital decompression may be the optimal therapy method. We evaluated 13 patients with steroid-resistant DON to determine the potential benefit of this surgical intervention.

Thirteen patients with steroid-resistant DON seen at Shenzhen Eye Hospital (China) between January 2023 and April 2025 were included in our study. All patients underwent emergent transnasal endoscopic orbital decompression and received postoperative corticosteroids and neurotrophic medication. The rate of improvement in postoperative best-corrected visual acuity (BCVA) was an important criterion for successful postoperative therapy.

In all, 13 patients (range, 34-72 y) with 13 eyes (8 right eyes and 5 left eyes) were included in our study. The duration of DON ranged from 9 to 36 months (median time 17.4 mo). Eleven of 13 patients (84.61%) had a statistically significant improvement in BCVA from 0.76±0.28 LogMAR to 0.23±0.18 postoperatively ( P <0.01). These 11 patients underwent decompression within <26 months of diagnosis. Three of these 11 patients demonstrated pronounced BCVA improvement: 2 of them improved from counting fingers to 0.6 and 0.02, respectively, and the other improved from hand motion to 0.3. However, the remaining 2 showed no improvement.

Emergent transnasal endoscopic orbital decompression surgery is a very useful and effective treatment for dysthyroid optic neuropathy (DON) that is refractory to corticosteroid therapy. Its efficacy seems inversely correlated with disease duration rather than preoperative BCVA. As such, longer disease duration may be associated with poorer postoperative outcomes.