A combined model of BCVA, TRAb, and NLR predicts response to intravenous methylprednisolone in dysthyroid optic neuropathy.
A combined model of BCVA, TRAb, and NLR predicts poor response to steroid treatment in dysthyroid optic neuropathy
A combined model of BCVA, TRAb, and NLR predicts response to intravenous methylprednisolone in dysthyroid optic neuropathy.
High-dose intravenous methylprednisolone (high-dose intravenous methylprednisolone) is the first-line treatment for dysthyroid optic neuropathy (dysthyroid optic neuropathy).
This retrospective study aimed to identify risk factors associated with a poor response to high-dose intravenous methylprednisolone in dysthyroid optic neuropathy patients, develop a predictive model for clinical decision-making, and assist in determining the optimal timing of orbital decompression surgery.
A retrospective cohort study was conducted involving 44 patients (44 eyes) diagnosed with dysthyroid optic neuropathy and treated with high-dose intravenous methylprednisolone.
how well the combined score tells apart patients who will vs won't recover
At the 6-month follow-up, 20 of the 44 (42.5%) eyes achieved complete visual recovery and consequently avoided surgical decompression.
A multivariable analysis identified three independent predictors of non-response to high-dose intravenous methylprednisolone: poorer baseline best-corrected visual acuity (BCVA; odds ratio [OR] = 1.43, 95% CI: 1.05-1.95, p = 0.04), higher thyroid-stimulating hormone receptor antibody (TRAb) levels (95% CI: 1.02-2.61, p = 0.04), and elevated NLR (OR = 1.30, 95% CI: 1.04-1.63, p = 0.02).
This study establishes that baseline BCVA, TRAb, and NLR are significant and readily available risk factors for failure of high-dose intravenous methylprednisolone in dysthyroid optic neuropathy.
The developed combination model provides clinicians with a valuable tool for the early identification of patients who are unlikely to benefit from medical therapy alone, thereby facilitating timely surgical intervention to prevent permanent visual damage and improve overall management outcomes.
External validation of this model is required in future prospective studies.