Purchase this article with an account.
Courtney Kauh, Shivani Gupta, Raymond S Douglas, Christine Nelson, Victor M Elner, Alon Kahana; Compressive Optic Neuropathy and Repeat Orbital Decompression: A Case Series. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4077.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To characterize the presenting characteristics, pre-operative clinical activity score (CAS), surgical approach, and visual outcomes in patients with thyroid eye disease (TED) undergoing repeat orbital decompression for recurrent or recalcitrant compressive optic neuropathy (CON).
The medical records of patients with recurrent or recalcitrant CON undergoing repeat orbital decompressions were retrospectively reviewed. The primary outcome measures included pre- and post-operative Humphrey visual field (HVF) mean deviation, visual acuity (VA) measured in logarithm of the minimal angle of resolution (LogMAR), color vision with Ishihara plates, and presence of relative afferent pupillary defect. Details of the surgical procedure and each patient’s CAS score at presentation were also recorded.
Six patients, 9 orbits, with a mean pre-operative CAS score of 3.4 were included in this review. The mean time between initial decompression and CON symptom recurrence for patients with recurrent CON was 9.5 years (range, 5.5-15 years). At presentation, the average HVF mean deviation was -16.5 (standard deviation (SD): 8.8), improving to -3.8 (2.4) post-operatively with a mean of 9.3 months follow-up (mean improvement of 75%). Pre-operative visual acuity was 0.34 (0.23) LogMAR, improving to 0.05 (0.10) logMAR with a mean follow up of 10.4 months. 8 of the 9 orbits presented with decreased VA, 4 with reduced color vision, and 1 with a relative afferent pupillary defect. All orbits demonstrated improvement of these measures following repeat orbital decompression.
In patients with thyroid-related orbitopathy, symptoms of recurrent CON occurred up to 15 years following initial orbital decompression, underscoring the smoldering, progressive nature of the disease. Repeat decompression which focused on the orbital apex resulted in visual improvement in all 9 orbits. Despite clinical evidence of CON, the mean CAS score of these patients at presentation was only 3.4, suggesting that patients should continue to have regular ophthalmic exams following decompression, and that physicians should be aware of the possibility of progressive recurrent CON in the absence of increased CAS or other external manifestations of disease.
This PDF is available to Subscribers Only