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Master Thesis

Résultats et facteurs prédictifs de la chirurgie de Décompression Orbitaire dans la Neuropathie Optique Dysthyroïdienne

Abstract : Purpose: to evaluate surgical outcomes and predictive factors in Orbital Decompression (OD) for Dysthyroid Optic Neuropathy (DON). Methods: we performed a retrospective review of all patients undergoing OD for DON between 2005 and 2020 in our two centers. The number of walls treated was limited to reduce the morbidity of the surgery. Demographic, medical, and surgical covariates were collected. Primary outcomes were improvement in Best Corrected Visual Acuity (BCVA) and Visual Field (VF) within 6 months after surgery. Proptosis and intraocular pressure (IOP) measurements were also recorded. We performed univariate and multivariate linear analysis to identify potential factors associated with visual outcomes. Results: 38 patients (58 eyes) undergoing OD for DON were included. Visual acuity improved by - 0,3 logMAR (P < 0,05). The MD improved by -3,6 dB for the Octopus® VF and by 3,1 dB for the Humphrey® VF (p<0,05). The full field 135 screening test showed an improvement of 40,8 points (p<0,05). Proptosis was significantly reduced by 2,7 mm (p<0,05) and IOP also decreased by 2,8 mmHg (p<0,05). A significant improvement in visual function could be achieved in 82,8 % of DON. Ten DON required further OD. The final succes rate was 96,6% after additional surgery. The absence of proptosis, DON diagnosis made in emergency and severe inflammation were associated with poorer VF improvement (p<0.05). The presence of dense or temporal or inferior scotomas and DON diagnosis made in emergency were associated with less improvement in visual acuity (p<0.05). Conclusion: OD is an effective treatment for DON resistant to intravenous corticosteroid therapy. A surgical technique limiting the number of structures treated is effective. The presence of an inferior scotoma, a severe inflammation, the absence of proptosis, and a delayed diagnosis of DON are predictive factors for poor prognosis in OD for the treatment of DON.
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Submitted on : Wednesday, October 21, 2020 - 12:26:26 PM
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Élise Coirier. Résultats et facteurs prédictifs de la chirurgie de Décompression Orbitaire dans la Neuropathie Optique Dysthyroïdienne. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02973840⟩

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