title: Complete recovery of visual acuity as the main goal of treatment in patients with dysthyroid optic neuropathy.
abstract: BACKGROUND
  To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy.
  
  
  METHODS
  The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA< 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment - intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment - endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment - additional MP therapy and/or surgical decompression.
  
  
  RESULTS
  A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves' orbitopathy clinical activity score (p = 0.035).
  
  
  CONCLUSIONS
  By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON.
authors.affiliation: Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland. pmiskiewicz@wum.edu.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Miśkiewicz
authors.forename: Beata
authors.initials: B
authors.lastname: Rutkowska
authors.forename: Anna
authors.initials: A
authors.lastname: Jabłońska
authors.forename: Antoni
authors.initials: A
authors.lastname: Krzeski
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Trautsolt-Jeziorska
authors.forename: Dariusz
authors.initials: D
authors.lastname: Kęcik
authors.forename: Justyna
authors.initials: J
authors.lastname: Milczarek-Banach
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Pirko-Kotela
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Samsel
authors.forename: Tomasz
authors.initials: T
authors.lastname: Bednarczuk
mesh_terms: D000328:Adult; D000368:Aged; D003117:Color Vision Defects / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D005260:Female; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D008775:Methylprednisolone
keywords: Graves’ disease; Graves’ orbitopathy; dysthyroid optic neuropathy; endoscopic intranasal orbital decompression; methylprednisolone; orbital decompression