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Orbital CT scan parameters in dysthyroid optic neuropathy: a systematic review and meta-analysis

Eye (2024)Cite this article

Subjects

Abstract

Purpose

Addressing Dysthyroid Optic Neuropathy (DON) is crucial due to its debilitating impact in thyroid eye disease (TED). Prompt treatment can preserve vision. Despite lacking definitive diagnostic criteria, computed tomography’s (CT) parameters are commonly used for diagnosis. However, these parameters exist without consensus on their diagnostic performance.

Design

Systematic review and meta-analysis.

Methods

We conducted a meta-analysis of studies assessing orbital CT diagnostic performance for DON in adults with TED. We searched various databases including Medline, PubMed, Scopus, and EMBASE, and others electronic databases, until July 2023. Evaluated CT parameters includes Barrett index (BI), fat prolapse via superior-orbital-fissure (SOF), superior-ophthalmic-vein-dilatation (SOVD), and the Nugent score. Diagnostic Test Accuracy analysis (DTA) was performed using R.

Results

A total of 9 articles with documented target parameters, collectively analysed 212 orbits with DON. Nugent score exhibited highest diagnostic ability with a log diagnostic odd ratio (logDOR) of 2.64 (95% CI, 2.02, 3.25). Another significant DON indicator was a BI ≥ 50%, with a logDOR of 1.97 (95% CI, 1.17; 2.77). Conversely, fat prolapse via SOF and SOVD proved less sensitive, with a logDOR of 1.42 and 1.09 respectively. Regarding the SROC curve, Nugent score and the BI have the greatest AUC. Variations in study locale, participant demographics, and measurement methods accounted for heterogeneity in meta-analysis.

Conclusions

Nugent score and a BI ≥ 50% prove to be significant diagnostic parameters for DON, distinguishing them from fat prolapse via SOF and SOVD. Prioritizing these parameters can lead to prompt treatment and thus enhanced visual outcomes.

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CRD42023446376.

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Fig. 1: SROC plot of Diagnostic test performance for each parameter.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Surgery, Sawanpracharak Hospital, 3 Attakavee, Pak Nam Pho, Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand

    Thansit Srisombut & Arparat Kanacharoen

  2. Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2, Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand

    Niracha Arjkongharn, Nattaporn Vongsa & Parinee Kemchoknatee

Authors
  1. Thansit Srisombut
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  2. Niracha Arjkongharn
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  3. Nattaporn Vongsa
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  4. Arparat Kanacharoen
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  5. Parinee Kemchoknatee
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Contributions

T.S.: conceptualization, senior reviewer, data curation, formal analysis, investigation, methodology, visualization, draft preparation of original manuscript, writing —review & editing., N.A.: data curation, writing & review., N.V.: data curation, writing & review., A.K.: data curation, writing & review., P.K.: conceptualization, senior reviewer, formal analysis, visualization, supervision, writing & review.

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Correspondence to Parinee Kemchoknatee.

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Srisombut, T., Arjkongharn, N., Vongsa, N. et al. Orbital CT scan parameters in dysthyroid optic neuropathy: a systematic review and meta-analysis. Eye (2024). https://doi.org/10.1038/s41433-024-03011-6

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