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Sheila Goyal, Mark Slabaugh, Shu-Hong Chang; THYROID EYE DISEASE WITH COMPRESSIVE OPTIC NEUROPATHY: DECOMPRESSION VERSUS RADIATION. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5911.
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While orbital radiation has been used to treat severe thyroid eye disease (TED) with good outcomes, evidence is limited to small case series which exclude patients with compressive optic neuropathy. There are data to show that both decompression and radiation are effective for optic neuropathy, but no studies have directly compared the two. The purpose of this study is to examine the outcomes of patients who underwent surgical decompression versus orbital radiation for TED with compressive optic neuropathy.
Retrospective chart review of patients who received surgical decompression and/or radiation for TED-associated optic neuropathy. Short and long-term outcomes for both groups were quantified using the following: logMAR visual acuity, color plates, pupillary response, optic nerve appearance, and Humphrey visual field testing. Information was collected regarding any radiation-related complications.
Eleven eyes underwent surgical decompression only. One eye underwent orbital radiation only. Six eyes received both interventions sequentially. Patients in all groups responded positively to treatment. Interestingly, several eyes with only partial response to surgical decompression achieved further improvement with subsequent orbital radiation. Only one patient experienced possible radiation-related complication.
Surgical decompression of the orbit is an effective treatment for TED-associated optic neuropathy. Radiation, though less commonly used, may be a viable alternative for patients who are poor surgical candidates, or as adjuvant therapy in those with partial response to surgical decompression. The incidence of radiation-related complications appears to be low.
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