| Purpose To analyze the clinical features of retinal nerve fiber layer thickness and the effect of orbital decompression on the thickness of retinal nerve fiber layer in patients with thyroid associated ophthalmopathy.To investigate the effect of glucocorticoids on ocular surface changes in patients with thyroid associated ophthalmopathy.Methods The first and second part of the study retrospectively included 191patients with TAO from January 2017 to January 2018 in the department of ophtha lmology,Changzheng Hospital,a total of 382 eyes,and 10 healthy controls in the sa me period,a total of 20 eyes.110 patients,a total of 163 eyes with TAO who und erwent orbital decompression surgery in the same period were retrospectively analyz ed,.Collecting and measuring the best-corrected visual acuity,intraocular pressure,e xophthalmos and RNFL thickness of all patients.The surgical patients recorded BC VA,exophthalmos and RNFL thickness measurements in the first month after surge ry.The differences between TAO patients and control group,and the differences o f TAO patients before and after the orbital decompression surgery were analyzed.T he third part of the study,for a total of 60 eyes of 30 patients with thyroid-associat ed ophthalmopathy,the break-up time of tear film(BUT),the partial blink rates,to tal blinks,the thickness of tear film lipid layer(LLT)and the fluidity of tear film li pid layer were examined before and after glucocorticoid treatment.The differents of each detection indexes were compared and analyzed.Results1.In the seven quadrants(TS,T,NS,N,NI,G)around the optic disc,the RNFL thickness of the TAO patient groups and the control group was statistically differe nt(p<0.05),the RNFL thickness was increased in the TS,NS,N,NI quadrants in the severe active group.The thickness of the RNFL was thinner in the T quadrant(p<0.05).In the moderate-to-severe active group,The thickness of RNFL was increase d in the NS,N,NI,G quadrants(p<0.05).In the moderate-to-severe inactive group,th e thickness of RNFL was increased in the NS,N quadrants(p<0.05).2.The severity of TAO,CAS score,intraocular pressure were correlated with RNFL thickness.The severity of TAO was positively correlated with the thickness of RNFL in TS,NS,N,NI quadrants(r_s>0,p<0.05),and was negatively correlated with the thickness of RNFL in T quadrant(r_s<0,p<0.05).The CAS score was positively correlated with the thickness of RNFL in TS,NS,N,NI,G quadrants(r_s>0,p<0.05),Th e exophthalmos was positively correlated with the thickness of RNFL in N,NI quad rants(r_s>0,p<0.05),and was negatively correlated with the thickness of RNFL in T quadrant(r_s<0,p<0.05).3.The exophthalmos was decreased in the moderate-to-severe group after surger y(pre-exophthalmos was 20.95±1.98 mm,post-exophthalmos was 15.81±1.91mm,p=0.00).The BCVA of DON group was improved(the medians of pre-BCVA and po st-BCVA were 0.3,0.6,p=0.00),and the exophthalmos was decreased(pre-exophthal mos is 20.69±2.15 mm,post-exophthalmos was 17.86±2.37mm,p=0.00)after surger y.4.In the moderate-to-severe group,the thickness of RNFL in the TS,N,NI quad rants was decreased after surgery(p<0.05);in the severe group,the thickness of R NFL in the TS,TI,NS,N,NI,G quadrants was decreased after surgery(p<0.05).5.The post-BCVA was positively correlated with the pre-BCVA(rs>0,p<0.05).The pre-BCVA was negatively correlated with the RNFL thickness in the TS,NS,N,NI,G quadrants(rs<0,p<0.05).The post-BCVA was negatively correlated with the R NFL thickness of the retinal fibrous layer in the TS,NS,N quadrants(rs<0,p<0.05).6.The break-up time of tear film in patients with thyroid-associated ophthalmop athy after glucocorticoid treatment was longer than before(the medians were 5s an d 7s,P<0.001),and the average,maximum and minimum of tear film lipid layer thickness after glucocorticoid treatmentwere increased than before(the medians of LLT-ave were 59 nm and 64.5 nm,LLT-max were 73.5 nm and 78.8 nm,and LLT-m in were 52.4 nm and 57.5 nm,respectively,P<0.01).Conclusions1.The RNFL thickness distribution is similar between the TAO patient groups and the healthy control group,but the RNFL thickness in the TAO patient group is thicker than control.2.The RNFL thickness of TAO patients begins to decrease from NS,N,NI,G q uadrants.As the severity and the activity of the disease increase,the range of RNF L thickening gradually extends to temporal quadrants,and the degree of thickness al so gradually increase,but the thickness of the RNFL on the temporal side becomes thinner.3.The severity of TAO,CAS score,intraocular pressure and RNFL thickness were correlated.The severity of TAO disease was positively correlated with the thi ckness of RNFL except the TI?G quadrants,and negatively correlated with the thi ckness of RNFL in the T quadrant.The CAS score was positively correlated with t he thickness of RNFL in the TS,NS,N,NI,G quadrants.The intraocular pressure was positively correlated with the thickness of RNFL in the TS,NI,G quadrants.The e xophthalmos was positively correlated with the thickness of RNFL in the N,NI,G q uadrants,and negatively correlated with the thickness of RNFL in the T quadrant.4.RNFL thickness changes may occur in the early stages of the TAO.OCT c an provide early and accurate identification of changes in the RNFL thickness in T AO patients and provides valuable information for assessing disease severity and act ivity at diagnosis and follow-up.Early diagnosis of optic neuropathy will help to ti mely assessment and treatment and prevent from the development of more serious c onsequences.5,Orbital decompression can effectively reduce the thickness of RNFL in TAO patients,especially in patients with DON,surgical treatment can effectively reduce retinalnerve compression and improve the visual of patients.6.Glucocorticoid treatment can improve the lipid secretion of tear film,thus ke ep maintaining the stability of tear film. |
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