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

作　　者：Ming-Na Xu Zhao-Qi Pan Yun-Hai Tu He-Qing Tao Ke-Si Shi Wen-Can Wu 

机构地区：[1]The Eye Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang Province,China [2]Peking University Third Hospital,Beijing 100000,China [3]The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,Zhejiang Province,China

出　　处：《International Journal of Ophthalmology(English edition)》2021年第7期1107-1113,共7页国际眼科杂志（英文版）

基　　金：Supported by the Natural Science Foundation of China(No.81770926);the Natural Key Research and Development Program of China(No.2016YFC1101200)。

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.

关 键 词：dysthyroid optic neuropathy GLUCOCORTICOID orbital decompression 

分 类 号：R581[医药卫生—内分泌] R774.6[医药卫生—内科学]