Purpose

The aim of this study was to evaluate visual acuity, visual evoked potentials and retinal nerve fiber layer parameters after orbital decompression surgery in vision threatening thyroid ophthalmopathy

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Methods

Twenty five eyes of 14 patients were included. Unilateral surgery was performed in 3 patients and bilateral surgery in 11. Medial wall decompression was performed in 11 patients, medial+lateral decompression in 2 and medial+inferior decompression in 1. BCVA, intraocular pressure, Hertel measurements, clinical activity scores, Ishihara tests, visual field mean deviation, VEP parameters and OCT based RNFL+GCC measurements were evaluated preoperatively and at postoperative 1 week, 1 month, 3 months. Generalized estimating equation analysis was performed

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Results

The mean age of the patients was 47.49±8.46 years and the female/male ratio was 8/6. A significant decrease was observed in Hertel measurements between the preoperative and postoperative 3rd month evaluations (24.56±2.94 and 21.52±2.30 mm, respectively; p≤0.001). CAS was found to decrease significantly at all follow-up visits (preoperative: 4.56±1.63 vs. 1st month 2.42±1.91 and 3rd month 1.47±1.12, p≤0.001). Significant improvements were observed in BCVA except the 1st postoperative week (preoperative 0.61±0.32, 1st week 0.74±0.20, p=0.065 and 1st month: 0.87±0.19, 3rd month: 0.93±0.20; p≤0.001), color vision (p≤0.001), and visual field measurements (p≤0.001) during follow-ups. The 15 degree pVEP amplitudes showed significant improvement starting at postoperative 1 month compared to preoperative measurements (7.29±3.95 µV vs. 10.23±4.12 µV; p=0.038), there were no significant difference at latency values (p=0.258). While a significant reduction in RNFL edema was observed during follow-up (p≤0.001), no significant change was detected in GCC measurements (p=0.772)

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Conclusion

In dysthyroid optic neuropathy, BCVA improves significantly after decompression surgery, whereas electrophysiological recovery becomes evident at postoperative 1 month. Optic nerve head swelling may decrease as early as the first postoperative week

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Additional Authors

First name	Last name	Base Hospital / Institution
Emrehan	Parlak	Marmara University Faculty of Medicine
Volkan	Dericioglu	Marmara University Faculty of Medicine

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