Therapeutic difference between orbital decompression and glucocorticoids administration as the first-line treatment for dysthyroid optic neuropathy: a systematic review

International Journal of Ophthalmology

He-Qing Tao¹  Zhao-Qi Pan²  Yun-Hai Tu²  Wen-Can Wu²  Ke-Si Shi³  Ming-Na Xu⁴ 

[1] Peking University Third Hospital, Beijing 100000, China;The Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China;The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China;Wen-Can Wu. The Eye Hospital of Wenzhou Medical College, No.270 Xueyuan Xi Road, Wenzhou 325027, Zhejiang Province, China. [e-mail];

关键词: dysthyroid optic neuropathy;    glucocorticoid;    orbital decompression;   

DOI  :  10.18240/ijo.2021.07.21

来源: DOAJ

【 摘 要 】

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy (DON). PubMed, EMBASE, the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcomes were the improvement in visual acuity and responder rate. Secondary outcomes were the proptosis reduction, change in diplopia, and clinical activity score (CAS). One randomized controlled trial, three retrospective case series and one prospective case series met the inclusion criteria. They were divided into intravenous high-dose glucocorticoids (ivGC) group and orbital decompression (OD) group. Both groups demonstrated improvement in visual acuity. In addition, the proportion of patients with improved vision in OD group was higher than that in ivGC group (P<0.001). Post-treatment proptosis reduction was also reported in both groups. Overall, weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively. This study also presented results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in 5 included studies. The most common complication in ivGC group and OD group was Cushing's syndrome and epistaxis respectively. The present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing proptosis. However, high-quality, large-sample, controlled studies need to be performed in the future.

【 授权许可】

Unknown