AIM: To evaluate the efficacy and safety of orbital decomposition(OD) surgery in combination with horse chestnut seed extract(HCSE), as compared to OD alone,in patients with thyroid-associated ophthalmopathy(TAO).METH...AIM: To evaluate the efficacy and safety of orbital decomposition(OD) surgery in combination with horse chestnut seed extract(HCSE), as compared to OD alone,in patients with thyroid-associated ophthalmopathy(TAO).METHODS: Sixty-two orbits from 62 TAO patients were randomly assigned to OD or OD +HCSE at 1:1 ratio(31received OD alone, 31 received OD +HCSE). Forty-two orbits from 21 healthy subjects were used as controls.Complete ophthalmic examination and color Doppler flow imaging(CDFI) were performed before surgery and 3mo post-surgery on all 62 orbits from the TAO patients.CDFI were also performed on the 42 control orbits. The effect of OD +HCSE and OD alone on TAO orbits was compared on several endpoints, including superior ophthalmic vein blood flow(SOVBF) parameters, subjective assessment, soft tissue involvement, lid retraction,diplopia, eye movement restriction, degree of exophthalmos, and intraocular pressure. The control orbits were used as reference for the SOVBF parameters.RESULTS: OD surgery with or without HCSE improved SOVBF, symptoms and soft tissue involvement,decreased degree of exophthalmos and intraocular pressure in orbits of TAO patients. The OD +HCSE combination led to significantly better improvement of SOVBF than OD alone. The differences between the reductions of SOVBF in the two groups are 1.26 cm/s in max-volecity and 0.52 cm/s in min-volecity(P <0.0001).CONCLUSION: SOVBF is significantly reduced in the orbits affected with TAO, indicating that congestion may be an important factor contributing to TAO pathogenesis.OD surgery improves the SOVBF, and combination of HCSE medication and OD surgery further improved venous return than OD surgery alone.展开更多
Thyroid-associated ophthalmopathy(TAO)is an autoimmune disease.Recent studies have found the aberrant epigenetics in TAO,including DNA methylation,noncoding RNAs,and histone modification.Many genes have an aberrant le...Thyroid-associated ophthalmopathy(TAO)is an autoimmune disease.Recent studies have found the aberrant epigenetics in TAO,including DNA methylation,noncoding RNAs,and histone modification.Many genes have an aberrant level of methylation in TAO.For example,higher levels are found in CD14,MBP,ANGLE1,LYAR and lower levels in DRD4 and BOLL.Non-coding RNAs are involved in the immune response(miR-146a,miR-155,miR-96,miR-183),fibrosis regulation(miR-146a,miR-21,miR-29),adipogenesis(miR-27)and are thought to play roles in TAO.MicroRNA is also related to the clinical activity score(miR-Let7d-5p)and may be a predictor of glucocorticoid therapy(miR-224-5p).The quantities of H4 in TAO are increased compared with euthyroid control subjects,and the role of histone modifications in Graves*disease may lead to better understanding of its role in TAO.More studies are needed to explain the role of epigenetics in TAO and provide potential therapeutic strategies.展开更多
AIM: To investigate whether the subtle change of choroidal/retinal vessel densities and volumes in thyroidassociated ophthalmopathy(TAO) could be an early sign to detect dysthyroid optic neuropathy(DON). METHODS: This...AIM: To investigate whether the subtle change of choroidal/retinal vessel densities and volumes in thyroidassociated ophthalmopathy(TAO) could be an early sign to detect dysthyroid optic neuropathy(DON). METHODS: This was a retrospective cross-sectional study, and a total of 98 eyes from 50 subjects were enrolled under certain criteria. Thirty-four eyes of normal controls and 64 eyes of TAO, including 39 eyes of DON and 25 eyes of TAO without DON, underwent optical coherence tomography angiography(OCTA) scanning. All the tested parameters of OCTA scanning including choroid radial peripapillary capillaries(RPC), retinal nerve fiber layer(RNFL), and macular ganglion cell complex(GCC) were compared among groups, and the correlation between OCTA parameters and visual function parameters was also investigated. RESULTS: Whole choroidal RPC was significantly reduced in DON(48.24%±0.4978%) compared to normal(50.33%±0.3173%) and TAO without DON(49.16%±0.5463%;P=0.0041). The reduction of whole choroidal RPC was also correlated with visual field(VF) defect in DON(r=0.5422, n=39). Although vision acuity and VF were improved in all the patients with DON after being treated with medical and surgical decompression, the reduction of RPC density were not reversed.CONCLUSION: There is a notable reduction in choroidal RPC in DON, which is correlated with VF defect. The reduction of RPC density could not be reversed immediately by medical and surgical decompression even when vision and VF were improved. These findings suggest that choroidal RPC could be a useful parameter to diagnose and monitor early stage of DON.展开更多
Objective Thyroid-associated ophthalmopathy(TAO)is an autoimmune disorder involving the orbital tissue.This study aimed to understand the role of regulatory T cells(Tregs)in TAO during 12-week systemic glucocorticoid(...Objective Thyroid-associated ophthalmopathy(TAO)is an autoimmune disorder involving the orbital tissue.This study aimed to understand the role of regulatory T cells(Tregs)in TAO during 12-week systemic glucocorticoid(GC)treatment.Methods Thirty-two moderate-severe TAO patients with a clinical activity score(CAS)≥3/7 or with prolonged T2 relaxation time(T2RT)on at least one side of extraocular muscle(EOM)were enrolled.The percentage of the peripheral CD4+CD25(high)CD127(−/low)Tregs was analyzed using flow cytometry before and after the GC treatment.The activity and severity of TAO,T2RT,and the clinical outcomes after the GC treatment were assessed.Their correlation with the peripheral Tregs was investigated.Results There was no significant association between the baseline Treg fraction and the activity and severity of TAO or the treatment response.A significant reduction of Tregs was observed after the GC therapy merely in patients without any clinical improvement.Conclusion Treg reduction after systemic GC therapy is indicative of a poor therapeutic response.Accordingly,dynamic alterations of Tregs could help to evaluate the effectiveness of the GC treatment.展开更多
目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)...目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)分析其与临床各项指标的相关性,并收集12例(24个眼眶)健康人测量球后脂肪体积,初步比较TAO组及健康组体积的差异。结果脂肪体积与病程成正相关(r=0.480,P<0.01),病程6个月以内组与6~12个月组相比,脂肪体积差异不显著(P=0.084)。病程6个月以内组及病程6~12个月组球后脂肪体积均显著低于病程大于12个月组(P<0.01,P<0.05)。脂肪体积与突眼度存在相关性(r=0.622,P<0.01),突眼度每增加1 mm,球后脂肪体积将增加0.88 m L。临床活动性评分(CAS)与SIR值及促甲状腺素受体抗体(TRAb)存在相关性(r=0.536,r=0.416,P<0.01)。TAO组球后脂肪体积显著高于正常组(P<0.01)。结论 TAO病程1年以上可能是球后脂肪组织增多的高峰阶段,球后脂肪体积结合SIR值的测量有助于最佳激素治疗时机的探索及预后分析。展开更多
Background:Hemodynamic changes have been observed in patients with Graves'disease.The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index(CVi)in patients with thyroid-a...Background:Hemodynamic changes have been observed in patients with Graves'disease.The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index(CVi)in patients with thyroid-associated ophthalmopathy(TAO).Methods:In this cross-sectional observational study,40 patients affected by TAO were recruited.Forty healthy individuals,matched for age and sex,served as controls.Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants.Images were binarized using the ImageJ software and luminal area(LA)and total choroidal area(TCA)were measured.CVI was calculated as the proportion of LA to TCA.The relation between CVI or subfoveal choroidal thickness(SFCT)and clinical activity score,exophthalmometric value,diplopia status,gender,and age was evaluated.Results:CVI was significantly higher in patients with TAO(P=0.004).No significant difference was observed in SFCT(P=0.200)and TCA(P=0.153)comparing TAO patients and healthy controls.LA was significantly higher in TAO group(P=0.045).On multiple regression analysis,CVI was associated with TCA(P=0.043).No association Was found between SFCT or CVI and TCA,clinical activity score,exophthalmometric value,Inami value,diplopia status,genderorage(P>0.05).Conclusions:This is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.展开更多
Background:Hemodynamic changes have been observed in patients with Graves’disease.The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index(CVI)in patients with thyroidassoc...Background:Hemodynamic changes have been observed in patients with Graves’disease.The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index(CVI)in patients with thyroidassociated ophthalmopathy(TAO).Methods:In this cross-sectional observational study,40 patients affected by TAO were recruited.Forty healthy individuals,matched for age and sex,served as controls.Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants.Images were binarized using the ImageJ software and luminal area(LA)and total choroidal area(TCA)were measured.CVI was calculated as the proportion of LA to TCA.The relation between CVI or subfoveal choroidal thickness(SFCT)and clinical activity score,exophthalmometric value,diplopia status,gender,and age was evaluated.Results:CVI was significantly higher in patients with TAO(P=0.004).No significant difference was observed in SFCT(P=0.200)and TCA(P=0.153)comparing TAO patients and healthy controls.LA was significantly higher in TAO group(P=0.045).On multiple regression analysis,CVI was associated with TCA(P=0.043).No association was found between SFCT or CVI and TCA,clinical activity score,exophthalmometric value,Inami value,diplopia status,gender or age(P>0.05).Conclusions:This is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.展开更多
Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this re...Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.展开更多
Background:The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density(RCD)around the macula in thyroid-associated ophthalmopathy(TAO)patients with or without dysthyr...Background:The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density(RCD)around the macula in thyroid-associated ophthalmopathy(TAO)patients with or without dysthyroid optic neuropathy(DON).Methods:Forty-four TAO patients including 23 non-DON and 21 DON patients,and 38 healthy participants were enrolled.Spectral domain optical coherence tomography equipped with Angiovue was used to obtain threedimensional retinal thickness maps and microvascular images of the superficial and deep retinal capillary layers(SRCL and DRCL,respectively)around the macula.Quantitative analyses were performed using a custom automated algorithm.Results:The thicknesses of the nerve fiber layer,ganglion cell layer+inner plexiform layer,and ganglion cell complex(GCC)as well as the RCDs in the SRCL and DRCL in both TAO groups were significantly decreased compared to the controls.In addition,the RCDs in DRCL of the DON group were further decreased compared to the non-DON group.GCC thickness in both TAO groups was positively correlated with the RCDs of the SRCL in the total annular zone and in the temporal,inferior,and nasal sectors.The areas under the receiver operating characteristic curves for the GCC thickness combined with the RCD were generally larger than those of each single indicator.Conclusions:Thinned inner intra-retinal layers and decreased RCDs in the TAO patients without DON revealed that morphological changes might precede visual dysfunction.The composite index of the retinal structure and the microvascular density might be valuable in the diagnosing,monitoring,and intervention for early DON.展开更多
Background:The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density(RCD)around the macula in thyroid-associated ophthalmopathy(TAO)patients with or without dysthyr...Background:The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density(RCD)around the macula in thyroid-associated ophthalmopathy(TAO)patients with or without dysthyroid optic neuropathy(DON).Methods:Forty-four TAO patients including 23 non-DON and 21 DON patients,and 38 healthy participants were enrolled.Spectral domain optical coherence tomography equipped with Angiovue was used to obtain three-dimensional retinal thickness maps and microvascular images of the superficial and deep retinal capillary layers(SRCL and DRCL,respectively)around the macula.Quantitative analyses were performed using a custom automated algorithm.Results:The thicknesses of the nerve fiber layer,ganglion cell layer and inner plexiform layer,and ganglion cell complex(GCC)as well as the RCDs in the SRCL and DRCL in both TAO groups were significantly decreased compared to the controls.In addition,the RCDs in DRCL of the DON group were further decreased compared to the non-DON group.GCC thickness in both TAO groups was positively correlated with the RCDs of the SRCL in the total annular zone and in the temporal,inferior,and nasal sectors.The areas under the receiver operating characteristic curves for the GCC thickness combined with the RCD were generally larger than those of each single indicator.Conclusions:Thinned inner intra-retinal layers and decreased RCDs in the TAO patients without DON revealed that morphological changes might precede visual dysfunction.The composite index of the retinal structure and the microvascular density might be valuable in the diagnosing,monitoring,and intervention for early DON.展开更多
文摘AIM: To evaluate the efficacy and safety of orbital decomposition(OD) surgery in combination with horse chestnut seed extract(HCSE), as compared to OD alone,in patients with thyroid-associated ophthalmopathy(TAO).METHODS: Sixty-two orbits from 62 TAO patients were randomly assigned to OD or OD +HCSE at 1:1 ratio(31received OD alone, 31 received OD +HCSE). Forty-two orbits from 21 healthy subjects were used as controls.Complete ophthalmic examination and color Doppler flow imaging(CDFI) were performed before surgery and 3mo post-surgery on all 62 orbits from the TAO patients.CDFI were also performed on the 42 control orbits. The effect of OD +HCSE and OD alone on TAO orbits was compared on several endpoints, including superior ophthalmic vein blood flow(SOVBF) parameters, subjective assessment, soft tissue involvement, lid retraction,diplopia, eye movement restriction, degree of exophthalmos, and intraocular pressure. The control orbits were used as reference for the SOVBF parameters.RESULTS: OD surgery with or without HCSE improved SOVBF, symptoms and soft tissue involvement,decreased degree of exophthalmos and intraocular pressure in orbits of TAO patients. The OD +HCSE combination led to significantly better improvement of SOVBF than OD alone. The differences between the reductions of SOVBF in the two groups are 1.26 cm/s in max-volecity and 0.52 cm/s in min-volecity(P <0.0001).CONCLUSION: SOVBF is significantly reduced in the orbits affected with TAO, indicating that congestion may be an important factor contributing to TAO pathogenesis.OD surgery improves the SOVBF, and combination of HCSE medication and OD surgery further improved venous return than OD surgery alone.
基金the National Natural Science Foundation of China(No.82071006)Natural Science Foundation of Hunan Province(No.2020JJ4129)Independent Exploration and Innovation Project of Graduate Students in Central South University(No.2021zzts1086)。
文摘Thyroid-associated ophthalmopathy(TAO)is an autoimmune disease.Recent studies have found the aberrant epigenetics in TAO,including DNA methylation,noncoding RNAs,and histone modification.Many genes have an aberrant level of methylation in TAO.For example,higher levels are found in CD14,MBP,ANGLE1,LYAR and lower levels in DRD4 and BOLL.Non-coding RNAs are involved in the immune response(miR-146a,miR-155,miR-96,miR-183),fibrosis regulation(miR-146a,miR-21,miR-29),adipogenesis(miR-27)and are thought to play roles in TAO.MicroRNA is also related to the clinical activity score(miR-Let7d-5p)and may be a predictor of glucocorticoid therapy(miR-224-5p).The quantities of H4 in TAO are increased compared with euthyroid control subjects,and the role of histone modifications in Graves*disease may lead to better understanding of its role in TAO.More studies are needed to explain the role of epigenetics in TAO and provide potential therapeutic strategies.
基金Supported by the National Natural Science Foundation of China (No.81170874No.81900868)。
文摘AIM: To investigate whether the subtle change of choroidal/retinal vessel densities and volumes in thyroidassociated ophthalmopathy(TAO) could be an early sign to detect dysthyroid optic neuropathy(DON). METHODS: This was a retrospective cross-sectional study, and a total of 98 eyes from 50 subjects were enrolled under certain criteria. Thirty-four eyes of normal controls and 64 eyes of TAO, including 39 eyes of DON and 25 eyes of TAO without DON, underwent optical coherence tomography angiography(OCTA) scanning. All the tested parameters of OCTA scanning including choroid radial peripapillary capillaries(RPC), retinal nerve fiber layer(RNFL), and macular ganglion cell complex(GCC) were compared among groups, and the correlation between OCTA parameters and visual function parameters was also investigated. RESULTS: Whole choroidal RPC was significantly reduced in DON(48.24%±0.4978%) compared to normal(50.33%±0.3173%) and TAO without DON(49.16%±0.5463%;P=0.0041). The reduction of whole choroidal RPC was also correlated with visual field(VF) defect in DON(r=0.5422, n=39). Although vision acuity and VF were improved in all the patients with DON after being treated with medical and surgical decompression, the reduction of RPC density were not reversed.CONCLUSION: There is a notable reduction in choroidal RPC in DON, which is correlated with VF defect. The reduction of RPC density could not be reversed immediately by medical and surgical decompression even when vision and VF were improved. These findings suggest that choroidal RPC could be a useful parameter to diagnose and monitor early stage of DON.
基金supported by the National Natural Science Foundation of China(No.81100581)the Beijing Bethune Charitable Foundation(No.2021).
文摘Objective Thyroid-associated ophthalmopathy(TAO)is an autoimmune disorder involving the orbital tissue.This study aimed to understand the role of regulatory T cells(Tregs)in TAO during 12-week systemic glucocorticoid(GC)treatment.Methods Thirty-two moderate-severe TAO patients with a clinical activity score(CAS)≥3/7 or with prolonged T2 relaxation time(T2RT)on at least one side of extraocular muscle(EOM)were enrolled.The percentage of the peripheral CD4+CD25(high)CD127(−/low)Tregs was analyzed using flow cytometry before and after the GC treatment.The activity and severity of TAO,T2RT,and the clinical outcomes after the GC treatment were assessed.Their correlation with the peripheral Tregs was investigated.Results There was no significant association between the baseline Treg fraction and the activity and severity of TAO or the treatment response.A significant reduction of Tregs was observed after the GC therapy merely in patients without any clinical improvement.Conclusion Treg reduction after systemic GC therapy is indicative of a poor therapeutic response.Accordingly,dynamic alterations of Tregs could help to evaluate the effectiveness of the GC treatment.
文摘目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)分析其与临床各项指标的相关性,并收集12例(24个眼眶)健康人测量球后脂肪体积,初步比较TAO组及健康组体积的差异。结果脂肪体积与病程成正相关(r=0.480,P<0.01),病程6个月以内组与6~12个月组相比,脂肪体积差异不显著(P=0.084)。病程6个月以内组及病程6~12个月组球后脂肪体积均显著低于病程大于12个月组(P<0.01,P<0.05)。脂肪体积与突眼度存在相关性(r=0.622,P<0.01),突眼度每增加1 mm,球后脂肪体积将增加0.88 m L。临床活动性评分(CAS)与SIR值及促甲状腺素受体抗体(TRAb)存在相关性(r=0.536,r=0.416,P<0.01)。TAO组球后脂肪体积显著高于正常组(P<0.01)。结论 TAO病程1年以上可能是球后脂肪组织增多的高峰阶段,球后脂肪体积结合SIR值的测量有助于最佳激素治疗时机的探索及预后分析。
文摘Background:Hemodynamic changes have been observed in patients with Graves'disease.The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index(CVi)in patients with thyroid-associated ophthalmopathy(TAO).Methods:In this cross-sectional observational study,40 patients affected by TAO were recruited.Forty healthy individuals,matched for age and sex,served as controls.Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants.Images were binarized using the ImageJ software and luminal area(LA)and total choroidal area(TCA)were measured.CVI was calculated as the proportion of LA to TCA.The relation between CVI or subfoveal choroidal thickness(SFCT)and clinical activity score,exophthalmometric value,diplopia status,gender,and age was evaluated.Results:CVI was significantly higher in patients with TAO(P=0.004).No significant difference was observed in SFCT(P=0.200)and TCA(P=0.153)comparing TAO patients and healthy controls.LA was significantly higher in TAO group(P=0.045).On multiple regression analysis,CVI was associated with TCA(P=0.043).No association Was found between SFCT or CVI and TCA,clinical activity score,exophthalmometric value,Inami value,diplopia status,genderorage(P>0.05).Conclusions:This is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.
文摘Background:Hemodynamic changes have been observed in patients with Graves’disease.The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index(CVI)in patients with thyroidassociated ophthalmopathy(TAO).Methods:In this cross-sectional observational study,40 patients affected by TAO were recruited.Forty healthy individuals,matched for age and sex,served as controls.Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants.Images were binarized using the ImageJ software and luminal area(LA)and total choroidal area(TCA)were measured.CVI was calculated as the proportion of LA to TCA.The relation between CVI or subfoveal choroidal thickness(SFCT)and clinical activity score,exophthalmometric value,diplopia status,gender,and age was evaluated.Results:CVI was significantly higher in patients with TAO(P=0.004).No significant difference was observed in SFCT(P=0.200)and TCA(P=0.153)comparing TAO patients and healthy controls.LA was significantly higher in TAO group(P=0.045).On multiple regression analysis,CVI was associated with TCA(P=0.043).No association was found between SFCT or CVI and TCA,clinical activity score,exophthalmometric value,Inami value,diplopia status,gender or age(P>0.05).Conclusions:This is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.
基金supported by the Natural Key Research and Development Program of China(2016YFC1101200).
文摘Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.
基金This study was supported by research grants from the Natural Science Foundation of Zhejiang Province(LY19H120003)National Natural Science Foundation of China(81570880)Public Service Program of Wenzhou Science and Technology Bureau of China(Y20160151).
文摘Background:The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density(RCD)around the macula in thyroid-associated ophthalmopathy(TAO)patients with or without dysthyroid optic neuropathy(DON).Methods:Forty-four TAO patients including 23 non-DON and 21 DON patients,and 38 healthy participants were enrolled.Spectral domain optical coherence tomography equipped with Angiovue was used to obtain threedimensional retinal thickness maps and microvascular images of the superficial and deep retinal capillary layers(SRCL and DRCL,respectively)around the macula.Quantitative analyses were performed using a custom automated algorithm.Results:The thicknesses of the nerve fiber layer,ganglion cell layer+inner plexiform layer,and ganglion cell complex(GCC)as well as the RCDs in the SRCL and DRCL in both TAO groups were significantly decreased compared to the controls.In addition,the RCDs in DRCL of the DON group were further decreased compared to the non-DON group.GCC thickness in both TAO groups was positively correlated with the RCDs of the SRCL in the total annular zone and in the temporal,inferior,and nasal sectors.The areas under the receiver operating characteristic curves for the GCC thickness combined with the RCD were generally larger than those of each single indicator.Conclusions:Thinned inner intra-retinal layers and decreased RCDs in the TAO patients without DON revealed that morphological changes might precede visual dysfunction.The composite index of the retinal structure and the microvascular density might be valuable in the diagnosing,monitoring,and intervention for early DON.
基金supported by research grants from the Natural Science Foundation of Zhejiang Province(Grant No.LY19H120003)National Natural Science Foundation of China(Grant No.81570880)Public Service Program of Wenzhou Science and Technology Bureau of China(Grant No.Y20160151).
文摘Background:The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density(RCD)around the macula in thyroid-associated ophthalmopathy(TAO)patients with or without dysthyroid optic neuropathy(DON).Methods:Forty-four TAO patients including 23 non-DON and 21 DON patients,and 38 healthy participants were enrolled.Spectral domain optical coherence tomography equipped with Angiovue was used to obtain three-dimensional retinal thickness maps and microvascular images of the superficial and deep retinal capillary layers(SRCL and DRCL,respectively)around the macula.Quantitative analyses were performed using a custom automated algorithm.Results:The thicknesses of the nerve fiber layer,ganglion cell layer and inner plexiform layer,and ganglion cell complex(GCC)as well as the RCDs in the SRCL and DRCL in both TAO groups were significantly decreased compared to the controls.In addition,the RCDs in DRCL of the DON group were further decreased compared to the non-DON group.GCC thickness in both TAO groups was positively correlated with the RCDs of the SRCL in the total annular zone and in the temporal,inferior,and nasal sectors.The areas under the receiver operating characteristic curves for the GCC thickness combined with the RCD were generally larger than those of each single indicator.Conclusions:Thinned inner intra-retinal layers and decreased RCDs in the TAO patients without DON revealed that morphological changes might precede visual dysfunction.The composite index of the retinal structure and the microvascular density might be valuable in the diagnosing,monitoring,and intervention for early DON.
