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Functional outcomes and complications in refractory dysthyroid optic neuropathy management: Experience with 3 different surgical protocols. | LitMetric

AI Article Synopsis

  • Dysthyroid optic neuropathy (DON) is a serious complication of Graves' orbitopathy that may require different surgical approaches for effective management.
  • The study reviewed the outcomes of three surgical techniques: modified extended orbital apex decompression, two-wall decompression, and three-wall decompression in patients not responding to medications.
  • Results showed significant improvements in vision and eye health post-surgery for all methods, with no reported complications, highlighting the effectiveness of extended decompression options based on individual patient needs.

Article Abstract

Introduction: Dysthyroid optic neuropathy (DON) is the most severe complication of Graves' orbitopathy (GO) and its management may require decompression surgery. Clear recommendations do not exist about which surgery should be performed and how extended the decompression should be. In this paper we present our experience regarding the management of DON via 3 different surgical protocols: a modified extended orbital apex decompression, a 2 walls decompression (inferior and lateral) and a 3 walls decompression (inferior, lateral and medial) and evaluate the functional outcomes.

Methods: Retrospective evaluation of subjects affected by DON not responding to medical therapy has been performed. All patients were submitted to pre- and post-operative ophthalmologic evaluations and orbital and sinuses CT scan in order to evaluate functional and surgical outcomes.

Results: 27 patients were enrolled in the study. Surgical procedures were performed on 42 orbits. A statistically significant post-operative improvement was recorded in visual acuity, proptosis, color vision and fundus oculi evaluation for all groups. No patient developed major or minor complications after surgery.

Conclusions: Extended endonasal approach and 3 walls decompression have been proved effective in the management of DON. The choice between them is done according to degree of proptosis, general status and eye-surface damages.

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Source
http://dx.doi.org/10.1016/j.amjoto.2022.103451DOI Listing

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