Diagnosing and treating Compressive-Optic-Neuropathy in Thyroid Eye Disease (TED-CON)

Garip-Kübler, Aylin (2024): Diagnosing and treating Compressive-Optic-Neuropathy in Thyroid Eye Disease (TED-CON). Habilitationsschrift, LMU München: Medizinische Fakultät

Abstract

This cumulative postdoctoral thesis focuses on the topic of diagnosing optic nerve compression - a severe complication of Thyroid Eye Disease (TED). Beyond the analysis of the diagnostic methods, the publications included in thesis help us to detect subclinical cases and understand the treatment methods to preserve the vision in such patients. Although observed rarely, optic nerve compression in TED (TED-CON) patients affects 4-8% of patients with the Graves’ orbitopathy (GO). GO is an immune-mediated inflammatory disease attributed to glycosaminoglycan depositions by fibroblasts into the retrobulbar tissues resulting in fibrosis. The disease causes an enlargement of the extraocular muscles and increased volume of the orbital fat. GO can be classified as mild, moderate to severe or sight threatening. According to the Consensus Statement of the European Group on Graves’ Orbitopathy (EUGOGO), sight-threatening GO is described as TED-CON and/or corneal breakdown requiring immediate intervention to preserve vision. Lack of standardised diagnostic criteria is a major impediment to timely diagnosis and treatment of TED-CON. Existing diagnostic tools, such as visual field (VF) examination, color vision, visual acuity tests, not only require patient cooperation but also are largely subjective, and easily influenced by coexisting corneal problems and motility of the eye (e.g., double vision) in patients with GO. Therefore, it is very challenging to detect patients with optic nerve compression and give them the best treatment for preserving their visual acuity. The first line of treatment in TED-CON involves steroid-pulse treatment, also known as medical decompression. Severe cases of DON that do not respond to this initial therapy are often treated with surgical orbital decompression. In this postdoctoral thesis we identify diagnostic tools for detecting the disease in the subclinical phase and compare existing treatment methods of TED-CON in order to provide the best treatment to patients as early as possible.

• Dokumententyp: Habilitationsschriften
• Keywords: Compressive-Optic-Neuropathy in Thyroid Eye Disease, Graves Disease, Color vision test, Visual evoked potentials
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 2024