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• W4294920234 abstract "Objective: To evaluate the efficacy and safety of maximal orbital decompression surgery and intravenous glucocorticoid (ivGC) pulse therapy as the initial treatment for dysthyroid optic neuropathy (DON). Methods: Retrospective cohort study. Forty-three patients (66 eyes) with DON who were treated during April 2019 and November 2021 in Peking University People's Hospital were included. According to the treatment methods, they were divided into the glucocorticoid group (21 cases, 33eyes) and the surgery group (22 cases, 33eyes). The glucocorticoid group received a total dose of 7.5 g ivGC therapy, while the surgery group received maximal orbital decompression surgery. Clinical outcomes were recorded and assessed including pre-and post-treatment logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA), clinical activity score (CAS), visual evoked potential (VEP)-P100 wave amplitude and peak time, muscle index (MI), and clinical proptosis. Adverse effects were also recorded. Follow-up data at 6 months after surgery or ivGC therapy were used as the post-treatment data. Wilcoxon signed rank analysis, independent or paired sample t test, Mann-Whitney U test, Chi-square test were used for statistical analysis. Non-normal distribution data were expressed in M(IQR). Results: There was no significant difference (all P>0.05) between the two groups in terms of gender, age, course of disease or laterality, as well as baseline data such as pre-treatment BCVA, CAS, VEP-P100 wave amplitude and peak time, and MI. After treatment, logMAR BCVA of the glucocorticoid group increased significantly from 1.00 (0.65) to 0.70 (0.60), (Z=-4.55), while BCVA of the surgery group increased significantly from 1.00 (0.95) to 0.60 (0.55), (Z=-4.87). The post-treatment CAS of the glucocorticoid group decreased significantly from 5 (2) to 2 (2) (Z=-4.91), while that of the surgery group also decreased significantly from 5 (2) to 2 (2) (Z=-4.94). After treatment, the VEP-P100 wave amplitude of the glucocorticoid group increased significantly from (3.49±1.34) μV to (5.26±2.00) μV (t=-9.08), while that of the surgery group increased significantly from (3.21±1.74) μV to (4.78±2.36) μV (t=-9.24). After treatment, the P100 wave peak time of the glucocorticoid group was significantly shortened from (110.52±12.11) ms to (103.53±6.67) ms (t=4.67), while that of the surgery group was significantly shortened from (118.48±20.16) ms to (106.45±10.57) ms (t=2.84). There were significant differences between inner-group before and after treatment data (all P<0.001), whereas the inter-group after treatment data have no significant difference (all P>0.05). The orbital apex crowding relief (MI≤0.52) rate was 64% (21/33) in the glucocorticoid group and was 91% (30/33) in the surgery group, while the proportion of proptosis reduction (more than 2 mm) in the glucocorticoid group and the surgery group was 64% (21/33) and 94% (31/33), respectively. Surgery was better than ivGC therapy both in terms of orbital apex crowding relief and proptosis reduction (χ2=5.52, 7.34; both P<0.05). Serious adverse effects or complications occurred in none of the two groups. Mild adverse effects occurred in 38% (8/12) of the patients receiving glucocorticoids and in 59%(13/22) of the patients receiving surgical treatment, with no significant difference (P>0.05). Conclusions: Both maximal orbital decompression surgery and ivGC therapy can effectively improve the visual function and reduce the CAS of DON with high safety. Meanwhile, surgery has more advantages in relieving orbital apex crowding and reducing proptosis.目的： 评估最大化眼眶减压手术和糖皮质激素冲击治疗作为甲状腺相关眼病视神经病变（DON）初始治疗方案的疗效及安全性。 方法： 回顾性队列研究。收集2019年4月至2021年11月在北京大学人民医院诊治的43例（66只眼）DON患者资料，根据治疗方法分为激素组（21例，33只眼）和手术组（22例，33只眼）。激素组接受了总剂量7.5 g的糖皮质激素静脉冲击治疗；手术组接受了最大化眼眶减压手术治疗。记录治疗前后的最佳矫正视力（最小分辨角对数视力）、临床活动性评分（CAS）、视觉诱发电位（VEP）-P100振幅和潜伏期、肌肉指数（MI）、眼球突出度等指标，同时记录不良反应及其发生率；以手术后或糖皮质激素冲击治疗后6个月的复查结果作为治疗后数据。统计学分析主要采用Wilcoxon符号秩检验、配对及独立样本t检验、Mann-Whitney U检验和χ2检验；非正态分布数据以M（IQR）表示。 结果： 2个组患者性别、年龄、病程、眼别分布及治疗前最佳矫正视力、CAS、VEP-P100振幅和潜伏期、MI等基线数据差异均无统计学意义（均P>0.05）。治疗后，激素组的最佳矫正视力从1.00（0.65）改善至0.70（0.60）（Z=-4.55），手术组从1.00（0.95）改善至0.60（0.55）（Z=-4.87）；激素组CAS从5（2）分降至2（2）分（Z=-4.91），手术组从5（2）分降至为2（2）分（Z=-4.94）；激素组VEP-P100波的振幅从（3.49±1.34）μV提高至（5.26±2.00）μV（t=-9.08），潜伏期从（110.52±12.11）ms缩短至（103.53±6.67）ms（t=4.67）；手术组振幅从（3.21±1.74）μV提高至（4.78±2.36）μV（t=-9.24），潜伏期从（118.48±20.16）ms缩短至（106.45±10.57）ms（t=2.84）；组内治疗后与治疗前比较差异均有统计学意义（均P<0.001）；而治疗后2个组间比较差异均无统计学意义（均P>0.05）。治疗后，激素组和手术组的眶尖拥挤缓解（MI≤0.52）率为分别为64%（21/33）和91%（30/33），眼球突出度下降≥2 mm的比例分别为64%（21/33）和94%（31/33），手术组均高于激素组，差异均有统计学意义（χ2=5.52、7.34，均P<0.05）。2个组均未出现严重不良反应或并发症，激素组与治疗组轻度不良反应发生率分别为38%（8/21）与59%（13/22），差异无统计学意义（P>0.05）。 结论： 最大化眼眶减压手术和糖皮质激素冲击治疗均能有效改善DON患者的视功能、降低CAS。两种治疗方法均具有较高的安全性，并且在缓解眶尖拥挤和眼球突出方面，手术更具优势。." @default.
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• W4294920234 date "2022-09-11" @default.
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• W4294920234 title "[The treatment effect of maximal orbital decompression surgery and intravenous glucocorticoids pulse therapy for dysthyroid optic neuropathy]." @default.
• W4294920234 doi "https://doi.org/10.3760/cma.j.cn112142-20220114-00016" @default.
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