Orbital decompression appears helpful for thyroid-related orbitopathy

This retrospective study found that orbital decompression reduced inflammatory and congestive symptoms in patients with optic neuropathy from thyroid-related orbitopathy (TRO).

The authors believe this to be the first report of a reduction in inflammatory signs and symptoms after urgent surgical decompression for optic neuropathy.

They reviewed the charts of all 24 patients (31 orbits) who underwent orbital decompression surgery for optic neuropathy from TRO at one eye center between 2000 and 2010. All patients underwent the procedure within seven days of presentation.

Postoperatively, optic neuropathy resolved in 22 patients (29 orbits) while visual acuity improved in the remaining two patients. The mean preoperative 10-item clinical activity score, a measure of orbital pain and swelling, was 9.5; this improved significantly at 12 months postop to 2.1 in the operated eye and 3.2 in the nonoperated, contralateral eye.

The authors say this improvement may be due to lowered venous congestion, decreased intraorbital pressure and diminution in inflammatory factors.

They note that definitive intervention is traditionally initiated after the disease has stabilized. However, in this study they treated optic neuropathy with maximal decompression prior to disease stabilization and noted stability at one year. They say the results raise the question of whether early intervention for optic neuropathy improves clinical outcome.