Prise en charge des orbitopathies dysthyroidiennes modérées et sévères: à propos de 22 cas

Our study aimed to describe the therapeutic management of moderate and severe dysthyroid orbitopathies and to evaluate the factors associated with optic neuropathy as well as the prognostic factors of poor visual outcome using a statistical analysis. We conducted a retrospective study of 22 patients presenting with moderate to severe dysthyroid orbitopathy in at least one eye and hospitalized in the Department of Ophthalmology at the University Hospital Farhat Hached, Sousse over the period from 1998 to 2015. Therapeutic indications were based on activity and severity criteria of the Eugogo (European Group On Graves' Orbitopathy) as well as on the assessment of prognostic factors of poor visual outcome. The average age of our patients was 40 years, with a slight male predominance (54.5%). 68.2% of patients were euthyroid, 18.2% had a history of smoking. The most significantly associated factor with neuropathy was a compression in the orbital apex (p = 0.03). Treatment was based on intravenous corticosteroid therapy and/or orbital decompression based on disease activity and severity. Overall evolution after treatment was marked by an improvement in inflammatory signs and by the reduction of exophthalmia. Visual prognosis was worse in elderly patients (p = 0.0001), male sex (p = 0.03) and treated by iratherapy (p = 0.04). Given the limits of a retrospective study, our results were generally consistent with the literature. The assessment and the management of dysthyroid orbitopathy are not well understood. Cohort, probably multicenter studies should be conducted to improve its management.