| Objective: This study aims to compare the central macular choroidal thickness(CMCT)in the macular area of normal control subjects,patients with thyroid-associated ophthalmopathy(TAO)of moderate to severe degree,and patients with dysthyroid optic neuropathy(DON),and to evaluate the effect of orbital decompression surgery on the visual acuity,intraocular pressure,degree of exophthalmos,CMCT and blood flow in the orbit of TAO patients.Methods: A total of 29 TAO patients(42 eyes)who met the inclusion criteria and underwent surgical treatment in the ophthalmology department of Mianyang Central Hospital from January 2021 to January2022 were included in the study,and 10 healthy control subjects(10 eyes)were also included during the same period.According to the severity grading criteria of the European Group On Graves’ Orbitopathy(EUGOGO),the experimental group was divided into a moderate to severe TAO group and a DON group.The initial visual acuity,intraocular pressure,degree of exophthalmos,CMCT and general information of the three groups were recorded and compared for differences.All patients in the experimental group underwent orbital decompression surgery performed by the same surgeon under general anesthesia and different surgical techniques were chosen based on the patients’ condition.The changes in CMCT,visual acuity,intraocular pressure,degree of exophthalmos,and clinical activity score(CAS score)were compared before and after surgery.Results: A total of 39 patients(52 eyes)were included in this study,with 10 healthy controls(10 eyes),20 patients(30 eyes)in the moderate-to-severe group,and 9 patients(12 eyes)in the dysthyroid optic neuropathy(DON)group.The healthy control group consisted of 5 males and 5 females with an average age of(41.20 ± 3.29)years.The moderate-to-severe group had 8 males and 12 females with an average age of(41.75±3.77)years and an average disease duration of(6.45±1.82)months.The DON group had 4 males and 5 females with an average age of(43.33±4.06)years and an average disease duration of(3.78±1.72)months.There was no statistical difference in age and sex among the three groups(P=0.435;P=0.872).There was a statistically significant difference in disease duration between the moderate-to-severe group and the DON group(P=0.001).(1)Changes in CMCT: The preoperative CMCT of the DON group was 396.46 ± 17.61 μ m,the moderate-to-severe group was 335.77 ±11.60μm,and the healthy control group was 303.48±14.83μm.Both groups had statistically significant differences compared with the healthy control group(F=135.679,P < 0.001).The CMCT of the DON group decreased significantly at 3 months postoperatively to 355.13±15.59μm and at 6 months postoperatively to 339.61 ± 13.17 μ m,both with statistical significance(F=280.545,P < 0.001).The CMCT of the moderate-to-severe group at 3 months and 6 months postoperatively was325.00 ± 10.48 μ m and 321.04 ± 11.34 μ m,respectively,with a statistically significant decrease compared to the preoperative value(F=75.013,P<0.001).There was no statistically significant difference in the healthy control group at different time points(P=0.057).(2)Changes in ocular proptosis: The preoperative ocular proptosis of the DON group was 22.00±2.30 mm,the moderate-to-severe group was19.07 ± 1.84 mm,and the healthy control group was 11.85 ± 1.60 mm.Both groups had statistically significant differences compared with the healthy control group(F=79.413,P<0.001).The ocular proptosis of the DON group decreased significantly at 3 months postoperatively to 19.33±2.23 mm and at 6 months postoperatively to 17.83±1.70 mm,both with statistical significance(F=22.708,P<0.001).The ocular proptosis of the moderate-to-severe group at 3 months and 6 months postoperatively was16.07± 1.74 mm and 15.60± 1.98 mm,respectively,with a statistically significant decrease compared to the preoperative value(F=234.057,P<0.001).There was no significant change in ocular proptosis in the healthy control group(P=0.411).(3)Changes in intraocular pressure: At baseline,the intraocular pressure of the DON group was 21.85 ± 2.82 mm Hg,and that of the moderate to severe group was 18.89 ± 3.06 mm Hg,which was significantly different from the healthy control group(14.60 ± 1.51 mm Hg)(F=18.14,P<0.001).In the DON group,the intraocular pressure was 18.86 ± 3.05 mm Hg at 3 months post-surgery and 18.09 ± 1.37 mm Hg at 6 months post-surgery,both of which were significantly different from baseline(F=10.665,P=0.001).In the moderate to severe group,the intraocular pressure also showed a decreasing trend,with measurements of 16.65 ± 2.04 mm Hg and 16.03 ± 2.30 mm Hg at 3months and 6 months post-surgery,respectively,which were significantly different from baseline(F=28.58,P<0.001).The intraocular pressure in the healthy control group remained stable at all time points,with no statistically significant differences(P=0.092).(4)Changes in CAS score and visual acuity: The CAS score of the DON group was 5.33±1.44 points before surgery,3.75±0.87 points at 3months post-surgery,and 2.42±1.00 points at 6 months post-surgery,and the difference was statistically significant at all time points(F=29.885,P<0.001).The CAS score of the moderate to severe group was 1.63±0.49 points,the CAS score was 1.50±0.51 points in the postoperative 3months,and the CAS score in the postoperative 6 months was 1.43±0.50 points,which was statistically significant compared with the preoperative period(F=3.662,P<0.05).The CMCT and CAS scores in the baseline group were positively correlated.The best-corrected visual acuity before and after surgery in the healthy control group and moderate to severe group was 1.0,with no significant change(P>0.05).In the DON group,the best-corrected visual acuity was 0.64±0.22 before surgery,and there was a certain degree of improvement at 3 and 6 months post-surgery(0.43 ± 0.20 and 0.34 ± 0.15,respectively),which was significantly different from baseline(F=55.325,P<0.001).Conclusion:1.In patients with moderate to severe TAO and DON,the CMCT was higher than that of the normal control group,and the CMCT was positively correlated with disease activity.Therefore,CMCT can provide a certain reference value for judging disease severity and activity.2.Orbital decompression surgery can reduce CMCT in patients with moderate to severe TAO and DON,effectively alleviate orbital compression symptoms,and improve orbital blood circulation.CMCT can also serve as an objective,non-invasive,simple,and repeatable observation index to evaluate the effect of orbital decompression surgery.3.Orbital decompression surgery can effectively reduce the degree of proptosis in patients with TAO and improve their appearance.For patients with DON,orbital decompression surgery can also improve their visual acuity and reduce disease activity.Therefore,it is a safe and effective treatment option,especially for patients who are not responsive to conservative treatment,have contraindications,or have severe complications that threaten their vision. |
