Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss.
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.
Mensah
Aurore
A
Oculoplastics and Neuro-Ophthalmology department of Rothschild Eye Foundation of Paris, France. retinaa@gmail.com
Vignal-Clermont
Catherine
C
Mehanna
Chadi
C
Morel
Xavier
X
Galatoire
Olivier
O
Jacomet
Pierre-Vincent
PV
Morax
Serge
S
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
D005938:Glucocorticoids; D008775:Methylprednisolone