Letter to the Editor
Optic neuropathy after orbital decompression surgery
Neuropatía óptica tras la cirugía de descompresión orbitaria
A. Asorey-García
, R. Martínez-Chico, E. Santos-Bueso, J. García-Feijoo
Corresponding author
Unidad de Neurooftalmología, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico, San Carlos (IdISSC), Madrid, Spain
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Asorey-García, R. Martínez-Chico, E. Santos-Bueso, J. García-Feijoo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Asorey-García" "email" => array:1 [ 0 => "Almudena.asorey@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Martínez-Chico" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Santos-Bueso" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "García-Feijoo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Neurooftalmología, Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico, San Carlos (IdISSC), Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neuropatía óptica tras la cirugía de descompresión orbitaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 665 "Ancho" => 1000 "Tamanyo" => 79950 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography showing bilateral axial exophthalmos (asymmetrical, more pronounced in the RE) and elongation of the optic nerve.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Optic neuropathy is a possible, although very infrequent, complication of orbital decompression surgery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 62-year-old woman with hyperthyroidism and long-standing thyroid-associated orbitopathy due to diffuse and nodular hyperplasia of the thyroid gland. The patient had been previously treated with steroids and total thyroidectomy to control symptoms. Exophthalmos was measured at 25<span class="elsevierStyleHsp" style=""></span>mm in the right eye (RE) and 23<span class="elsevierStyleHsp" style=""></span>mm in the left eye (LE) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). We also observed mild lid retraction and a bilateral supraduction deficit. At that time, our patient was being treated with topical ocular hypotensive medication for chronic bilateral open-angle glaucoma that had been stable for 4 years.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In her last examination before surgery, we recorded intraocular pressure (IOP) of 18<span class="elsevierStyleHsp" style=""></span>mmHg in both eyes, as well as optic disc cupping of 0.6 and 0.4<span class="elsevierStyleHsp" style=""></span>mm in the RE and LE, respectively. Results from both the campimetry study and the optical coherence tomography (OCT) performed before surgery were normal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient underwent orbital decompression surgery of the RE; the medial wall and orbital floor were removed endoscopically through the nasal cavity while the lateral wall was removed by the external approach. There were no complications.</p><p id="par0025" class="elsevierStylePara elsevierViewall">One week after the surgery, the patient reported loss of visual acuity, but findings from the ophthalmological examination were identical to those from the previous one except for decreased IOP in the RE (14<span class="elsevierStyleHsp" style=""></span>mmHg). We performed tendency oriented perimetry (TOP) of the central 30° visual field, which revealed an altitudinal scotoma of the LE visual field. An OCT of the optic nerve fibre layer showed reduced thickness of that layer (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In light of these data, our diagnosis was ischaemic optic neuropathy possibly associated with the orbital decompression surgery.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Orbital decompression surgery is a therapeutic option for thyroid orbitopathy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> This procedure is generally performed after failure of corticosteroid treatment or radiotherapy during the active phase of the disease when vision is highly impaired, mainly due to compressive optic neuropathy. This procedure is also performed during the inactive phase to surgically correct sequelae, mainly consisting of keratitis due to corneal exposure, proptosis causing diplopia, and cosmetic disfigurement.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> The procedure involves surgically opening orbital walls to create more space for the eye<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a> and thus reduce proptosis and IOP.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Some of its more frequent complications are (generally) transient infraorbital nerve hypaesthesia,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> sinusitis, epistaxis, oedema, and haematoma of the lids. New diplopia can occasionally develop and it usually resolves, although strabismus surgery may be required.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Ischaemic optic neuropathy has been described as an infrequent complication of orbital decompression surgery.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a> Studies have suggested that this may be due to a direct intraoperative lesion to the optic nerve or to intraoperative increased IOP.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Asorey-García A, Martínez-Chico R, Santos-Bueso E, García-Feijoo J. Neuropatía óptica tras la cirugía de descompresión orbitaria. Neurología. 2016;31:62–64.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 665 "Ancho" => 1000 "Tamanyo" => 79950 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography showing bilateral axial exophthalmos (asymmetrical, more pronounced in the RE) and elongation of the optic nerve.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1871 "Ancho" => 3275 "Tamanyo" => 762627 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">TOP of the 30° visual field and OCT of optic nerve fibre layers of the RE performed after orbital decompressive surgery. Studies respectively show a superior altitudinal defect and the corresponding decrease in thickness of the retinal nerve fibre layers in the lower sector.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of graves ophthalmopathy: reality and perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Bartalena" 1 => "A. Pinchera" 2 => "C. 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Prada Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2003" "volumen" => "78" "paginaInicial" => "407" "paginaFinal" => "431" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12955622" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optic neuropathy of Graves disease: results of transantral orbital decompression and long-term follow-up in 215 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.V. Saoers-Welch" 1 => "V. Fatourechi" 2 => "G.B. Bartley" 3 => "C.W. Beatty" 4 => "C.A. Gorman" 5 => "R.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 2 | 8 |
| 2024 October | 37 | 11 | 48 |
| 2024 September | 43 | 19 | 62 |
| 2024 August | 31 | 14 | 45 |
| 2024 July | 37 | 3 | 40 |
| 2024 June | 38 | 7 | 45 |
| 2024 May | 32 | 5 | 37 |
| 2024 April | 41 | 19 | 60 |
| 2024 March | 41 | 14 | 55 |
| 2024 February | 37 | 7 | 44 |
| 2024 January | 46 | 15 | 61 |
| 2023 December | 42 | 10 | 52 |
| 2023 November | 51 | 13 | 64 |
| 2023 October | 63 | 15 | 78 |
| 2023 September | 35 | 3 | 38 |
| 2023 August | 25 | 6 | 31 |
| 2023 July | 32 | 7 | 39 |
| 2023 June | 43 | 4 | 47 |
| 2023 May | 47 | 7 | 54 |
| 2023 April | 39 | 2 | 41 |
| 2023 March | 29 | 5 | 34 |
| 2023 February | 37 | 5 | 42 |
| 2023 January | 50 | 19 | 69 |
| 2022 December | 30 | 6 | 36 |
| 2022 November | 46 | 12 | 58 |
| 2022 October | 28 | 16 | 44 |
| 2022 September | 47 | 30 | 77 |
| 2022 August | 52 | 24 | 76 |
| 2022 July | 24 | 9 | 33 |
| 2022 June | 30 | 9 | 39 |
| 2022 May | 60 | 11 | 71 |
| 2022 April | 48 | 14 | 62 |
| 2022 March | 37 | 17 | 54 |
| 2022 February | 31 | 3 | 34 |
| 2022 January | 47 | 8 | 55 |
| 2021 December | 27 | 9 | 36 |
| 2021 November | 25 | 6 | 31 |
| 2021 October | 42 | 18 | 60 |
| 2021 September | 22 | 8 | 30 |
| 2021 August | 29 | 5 | 34 |
| 2021 July | 19 | 5 | 24 |
| 2021 June | 26 | 6 | 32 |
| 2021 May | 38 | 12 | 50 |
| 2021 April | 94 | 8 | 102 |
| 2021 March | 42 | 10 | 52 |
| 2021 February | 26 | 11 | 37 |
| 2021 January | 21 | 11 | 32 |
| 2020 December | 39 | 13 | 52 |
| 2020 November | 23 | 13 | 36 |
| 2020 October | 14 | 12 | 26 |
| 2020 September | 24 | 17 | 41 |
| 2020 August | 20 | 22 | 42 |
| 2020 July | 14 | 14 | 28 |
| 2020 June | 19 | 12 | 31 |
| 2020 May | 17 | 27 | 44 |
| 2020 April | 11 | 11 | 22 |
| 2020 March | 10 | 6 | 16 |
| 2020 February | 17 | 8 | 25 |
| 2020 January | 20 | 12 | 32 |
| 2019 December | 26 | 7 | 33 |
| 2019 November | 24 | 16 | 40 |
| 2019 October | 13 | 5 | 18 |
| 2019 September | 14 | 15 | 29 |
| 2019 August | 16 | 5 | 21 |
| 2019 July | 39 | 21 | 60 |
| 2019 June | 66 | 16 | 82 |
| 2019 May | 111 | 16 | 127 |
| 2019 April | 52 | 55 | 107 |
| 2019 March | 12 | 9 | 21 |
| 2019 February | 16 | 12 | 28 |
| 2019 January | 9 | 11 | 20 |
| 2018 December | 9 | 6 | 15 |
| 2018 November | 11 | 5 | 16 |
| 2018 October | 19 | 12 | 31 |
| 2018 September | 11 | 2 | 13 |
| 2018 August | 9 | 3 | 12 |
| 2018 July | 5 | 6 | 11 |
| 2018 June | 6 | 10 | 16 |
| 2018 May | 6 | 13 | 19 |
| 2018 April | 5 | 1 | 6 |
| 2018 March | 14 | 1 | 15 |
| 2018 February | 8 | 4 | 12 |
| 2018 January | 6 | 9 | 15 |
| 2017 December | 8 | 3 | 11 |
| 2017 November | 8 | 10 | 18 |
| 2017 October | 20 | 6 | 26 |
| 2017 September | 25 | 9 | 34 |
| 2017 August | 15 | 9 | 24 |
| 2017 July | 6 | 3 | 9 |
| 2017 June | 19 | 10 | 29 |
| 2017 May | 20 | 13 | 33 |
| 2017 April | 6 | 1 | 7 |
| 2017 March | 23 | 11 | 34 |
| 2017 February | 18 | 2 | 20 |
| 2017 January | 14 | 3 | 17 |
| 2016 December | 12 | 6 | 18 |
| 2016 November | 14 | 8 | 22 |
| 2016 October | 24 | 2 | 26 |
| 2016 September | 22 | 4 | 26 |
| 2016 August | 25 | 7 | 32 |
| 2016 July | 12 | 2 | 14 |
| 2016 June | 28 | 10 | 38 |
| 2016 May | 32 | 18 | 50 |
| 2016 April | 47 | 32 | 79 |
| 2016 March | 86 | 50 | 136 |
| 2016 February | 70 | 40 | 110 |
| 2016 January | 23 | 8 | 31 |
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