Retinal nerve fiber layer and ganglion cell complex thickness as a diagnostic tool in early stage dysthyroid optic neuropathy

Purpose To compare the diagnostic accuracy of peripapillary retinal nerve fiber layer with macular ganglion cell complex thickness as an auxiliary tool for the early diagnosis of dysthyroid optic neuropathy and help assess the effectiveness of the treatment. Methods In this retrospective case–control study, a total of 58 thyroid-associated opthalmopathy patients and 58 healthy participants were enrolled in the study. Thyroid-associated opthalmopathy patients were divided according to the European Group Graves’ Orbitopathy severity classification. The thicknesses of peripapillary nerve fiber layer and macular ganglion cell complex were measured using optical coherence tomography and their correlation with the severity of the disease as well as the effect of the treatment was investigated. Results No statistically significant differences were found between the mild thyroid-associated opthalmopathy group and the control group in both peripapillary nerve fiber layer and macular ganglion cell complex thickness. In the moderate-to-severe thyroid-associated opthalmopathy group, however, Temporal and Nasal peripapillary nerve fiber layer thicknesses were lower compared to the control group (p = 0.041, p = 0.012), whereas in the sight-threatening thyroid-associated opthalmopathy group Temporal Inferior, Nasal Superior, and mean (G) peripapillary nerve fiber layer thicknesses were larger (p = 0.000, p = 0.004, p = 0.000). No significant differences were observed in the macular ganglion cell complex thickness among the different severity groups and the control groups (p > 0.05). After treatment, the mean peripapillary nerve fiber layer thickness decreased whereas mean macular ganglion cell complex thickness showed no significant change in the sight-threatening group. A correlation was established between exophthalmos, best corrected visual acuity, clinical activity score, disease course, and the mean peripapillary nerve fiber layer thickness. The area under curve analysis indicated that mean peripapillary nerve fiber layer thickness can be used as a powerful diagnostic tool in early stage dysthyroid optic neuropathy in thyroid-associated opthalmopathy patients. Conclusion Our study indicates that peripapillary nerve fiber layer act as an auxiliary tool for the early diagnosis of dysthyroid optic neuropathy and helps assess the effectiveness of the treatment.

目的 比较视乳头周围视网膜神经纤维层和黄斑神经节细胞复合体厚度作为辅助工具在甲状腺相关眼病视神经病变早期诊断中的诊断准确性，并帮助评估治疗效果。方法 在这项回顾性病例对照研究中，共纳入58例甲状腺相关眼病患者和58名健康参与者。根据欧洲格雷夫斯眼病研究小组的严重程度分类对甲状腺相关眼病患者进行分组。使用光学相干断层扫描测量视乳头周围神经纤维层和黄斑神经节细胞复合体的厚度，并研究它们与疾病严重程度以及治疗效果的相关性。结果 在轻度甲状腺相关眼病组与对照组之间，视乳头周围神经纤维层和黄斑神经节细胞复合体厚度均未发现有统计学意义的差异。然而，在中重度甲状腺相关眼病组中，颞侧和鼻侧视乳头周围神经纤维层厚度较对照组降低（p = 0.041，p = 0.012），而在威胁视力的甲状腺相关眼病组中，颞下、鼻上和平均（G）视乳头周围神经纤维层厚度更大（p = 0.000，p = 0.004，p = 0.000）。不同严重程度组与对照组之间黄斑神经节细胞复合体厚度未观察到显著差异（p > 0.05）。治疗后，威胁视力组中平均视乳头周围神经纤维层厚度降低，而平均黄斑神经节细胞复合体厚度无显著变化。突眼度、最佳矫正视力、临床活动评分、病程与平均视乳头周围神经纤维层厚度之间建立了相关性。曲线下面积分析表明，平均视乳头周围神经纤维层厚度可作为甲状腺相关眼病患者甲状腺相关眼病视神经病变早期的有力诊断工具。结论 我们的研究表明，视乳头周围神经纤维层可作为甲状腺相关眼病视神经病变早期诊断的辅助工具，并有助于评估治疗效果。