Prognostic factors for significant 6-month recovery in dysthyroid optic neuropathy in a tertiary center: A series of 69 eyes in 38 patients.

PURPOSE: To identify initial features associated with significant recovery in patients with Graves' disease dysthyroid optic neuropathy (DON) treated according to EUGOGO guidelines by intravenous glucocorticoids (ivGC) and decompression surgery in first and second-line, respectively. PATIENTS AND METHODS: Consecutive patients referred to our expert multidisciplinary consultation over a 6-year period underwent systematic exploration: endocrine assessment, ophthalmic examination and radiological exploration. Visual recovery, based on best-corrected visual acuity (BCVA) and visual field (VF), were evaluated at baseline, 1week and 6months. Baseline parameters were then tested for prognostic value on univariate and multivariate analyses. RESULTS: Thirty-eight patients (69 eyes) with DON were included. Significant recovery at 6months was found in 48/69 eyes (70%), partial recovery in 18/69 (26%), and no recovery in 3/69 (4%). Fifty-one eyes (28 patients) required surgical decompression after ivGC. These patients showed more severe presentation at diagnosis, had received significantly less GC for Graves' orbitopathy before onset of DON, and showed greater fat prolapse on CT scans compared to non-operated patients. On multivariate analysis, male gender (P=0.001), cumulative GC dose>1g before DON diagnosis (P=0.048) and initial BCVA≤0.3 (P=0.004) were significantly associated with better outcomes, whereas Clinical Activity Score>5 (P=0.013) was associated with a poorer outcome. CONCLUSION: This study confirms a generally favorable 6-month recovery rate in DON treated according to EUGOGO guidelines and provides new information on baseline predictors of poor evolution. These results may help the respective indications for medical and surgical treatment to be more effectively combined in the future.

Choroidal Thickness in Birdshot Retinochoroiditis Over a 2-Year Period.

PURPOSE: To evaluate 2-year choroidal changes in eyes with birdshot retinochoroiditis (BRC). METHODS: Thirteen patients (26 eyes) with BRC were prospectively evaluated during a 2-year period with standard automated perimetry (SAP), fluorescein angiography, indocyanine green angiography and optical coherence tomography (Spectralis Heidelberg Retinal Angiograph + optical coherence tomography). Enhanced-depth imaging optical coherence tomography was performed. RESULTS: Eight patients (61%) were females; the patients mean age was 60 ± 4.7 (range 49-66) years. At baseline, best-corrected visual acuity (BCVA) was 0.08 ± 0.2 and foveal sensitivity threshold (FST) at SAP was 34.04 ± 2.6; at 2-year visit, no significant changes were observed (BCVA 0.06 ± 02, p = 0.1 and FST 34.36 ± 2.6, p = 0.1). In all cases, at the 2-year visit, a significant reduction of choroidal thickness was present only at the fovea (p = 0.01). The rate of foveal choroidal thinning was 1.8 ± 1.6 µm per month. When compared to baseline, suprachoroidal fluid (SCF) was more frequent (42.3 vs. 23%; p = 0.002). The amount of foveal choroidal thinning was associated with the presence of SCF at baseline (p = 0.005). CONCLUSION: In patients with BRC, foveal choroidal thinning and increase of SCF at 2-year follow-up can be observed, even in the absence of visual loss.