title: Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss.
abstract: OBJECTIVE
  Dysthyroid Optic Neuropathy (DON) can lead to irreversible visual loss. We report risk features correlated with poor visual recovery despite an intensive treatment in a series of patients with DON.
  
  
  METHODS
  Retrospective analysis of a non-comparative interventional series.
  
  
  METHODS
  Between 1997 and 2007, 300 consecutive patients with Graves' orbitopathy were seen at the Rothschild Foundation (Paris). Medical records of all consecutive patients who developed a DON were reviewed. Demographic, clinical features and visual function were collected at the time of the first onset, one month follow-up after medical and sometime surgical treatment and at the last examination. Statistical analysis (reflected as p values) gathered the significant observations into detrimental visual recovery prognostic factors for DON.
  
  
  RESULTS
  Fifty-six eyes of 29 patients developed a DON. Sixteen eyes (28%) did not improve vision despite usual treatment (intravenous steroids and surgical decompression when necessary). An inferior altitudinal visual field defect (AVF, p=0.0004) and/or a lack of response to intravenous steroids boluses (p= 0.011) were related to a poor recovery.
  
  
  CONCLUSIONS
  DON prognosis is highly variable. Our results suggest that a non-inflammatory element, probably vascular could be involved in atypical DONs. An earlier recognition could prompt to rapid surgical treatment for these patients.
authors.affiliation: Oculoplastics and Neuro-Ophthalmology department of Rothschild Eye Foundation of Paris, France. retinaa@gmail.com
authors.forename: Aurore
authors.initials: A
authors.lastname: Mensah
authors.forename: Catherine
authors.initials: C
authors.lastname: Vignal-Clermont
authors.forename: Chadi
authors.initials: C
authors.lastname: Mehanna
authors.forename: Xavier
authors.initials: X
authors.lastname: Morel
authors.forename: Olivier
authors.initials: O
authors.lastname: Galatoire
authors.forename: Pierre-Vincent
authors.initials: PV
authors.lastname: Jacomet
authors.forename: Serge
authors.initials: S
authors.lastname: Morax
mesh_terms: D017668:Age of Onset; D019299:Decompression, Surgical; D005074:Evoked Potentials, Visual; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D049970:Graves Ophthalmopathy / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone