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Ramesh S, Naik M, Watson A, Zhang Q, Peskin E, Sharpe J, Alessi K, Hyman L. Thyroid Eye Disease: Pilot Study Comparison Between Patients in United States-Based and India-Based Practices. Am J Ophthalmol 2024; 264:25-35. [PMID: 38484865 DOI: 10.1016/j.ajo.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/19/2024] [Accepted: 03/06/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Thyroid eye disease (TED) phenotype varies by ethnicity/race and genetic/environmental factors. This study compared demographic and clinical characteristics of TED patients from the US and India. DESIGN Observational pilot study . METHODS Sixty-four patients with TED ages ≥18 years old with active disease (onset of symptoms ≤18 months or presenting clinical activity score (CAS) ≥4) were recruited between March and October 2021 from clinical practices in the United States (Philadelphia, PA) (n = 30) and India (Hyderabad, India) (n = 34). Data collection at baseline and 3 months included clinical measurements, thyroid disease history, and photographs. Ocular symptoms and quality of life data were obtained by phone interview. CAS was calculated using the standard 7-point scale. RESULTS There was no statistically significant difference in age, TED duration, or smoking status between patient groups. Both groups had good vision, a low rate of optic neuropathy, and comparable exophthalmometry. US patients were predominantly female (86.7% [26/30]), with a history of hyperthyroidism (96% 29/30). In comparison, Indian patients were 52.9% (18/34, P = .004) female; underlying thyroid disease was distributed between hyperthyroidism (52%), hypothyroidism (17.6%) and euthyroid (9.7%). Mean (SD) CAS in the US cohort was double the score in the India cohort (4.2 (1.7) vs 1.65 (1.7), respectively) (P < .0001). However, patients at both sites experienced subjective symptoms of TED at a similar frequency. CONCLUSIONS Observed differences in TED between US and Indian patients warrant further investigation to elucidate differences in pathogenesis, disease expression, or other factors that may influence TED in diverse populations.
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Affiliation(s)
- Sathyadeepak Ramesh
- From the Department of Oculoplastics and Orbital Surgery (S.R., A.W.), Wills Eye Hospital, Philadelphia, Pennsylvania, USA; The Center for Eye and Facial Plastic Surgery (S.R.), Somerset, New Jersey, USA
| | - Milind Naik
- Ophthalmic Plastic Surgery Service (M.N.), LV Prasad Eye Institute, Hyderabad, India
| | - Alison Watson
- From the Department of Oculoplastics and Orbital Surgery (S.R., A.W.), Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Qiang Zhang
- Vickie and Jack Farber Vision Research Center (E.P., E.P., J.S., K.A., L.H.), Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Ellen Peskin
- Vickie and Jack Farber Vision Research Center (E.P., E.P., J.S., K.A., L.H.), Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Sharpe
- Vickie and Jack Farber Vision Research Center (E.P., E.P., J.S., K.A., L.H.), Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kieran Alessi
- Vickie and Jack Farber Vision Research Center (E.P., E.P., J.S., K.A., L.H.), Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center (E.P., E.P., J.S., K.A., L.H.), Wills Eye Hospital, Philadelphia, Pennsylvania; Wills Eye Hospital, Department of Ophthalmology (L.H.), Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Alali M, Alkulaib NS, Alkhars A, Albadri K, Al Hassan S, Elewa M, Aldairi W, Alsaqer SK, Al-Abdulqader RA, Alhammad F. Thyroid eye disease in Eastern Province of Saudi Arabia: clinical profile and correlation with vitamin D deficiency. Orbit 2024; 43:28-32. [PMID: 36855900 DOI: 10.1080/01676830.2023.2181975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE To obtain clinical data about disease activity and severity of thyroid eye disease (TED) in a tertiary eye hospital in the Eastern Province of Saudi Arabia and to correlate this data with vitamin D levels. METHODS A clinical observational study was conducted in a specialized eye hospital in Saudi Arabia. It included prospective enrollment of Saudi patients with confirmed TED to evaluate activity and severity according to Clinical Activity Score (CAS) and European Group on Graves' Orbitopathy (EUGOGO), respectively, and also for blood investigation, including thyroid profile and vitamin D levels. In addition, some retrospective data collection included previous medical and surgical treatment and complications. RESULTS A total of 74 TED patients were included, with a median age of 42 years and a female predominance of 64.9%. Smokers were 18.9%. A family history of thyroid disease was noted in 12.16% of patients. There were 10.8% of patients with active TED. A moderate to severe severity level was observed in 71% of the cases, mild in 15%, and sight-threatening in 6%. Smoking and older age were associated with the active form of TED. There was a 48.4% prevalence of vitamin D deficiency among TED patients and it was not associated with TED severity or activity. CONCLUSIONS This is the first study demonstrating the clinical profile of TED among Saudi patients. Smoking and older age were associated with TED. Vitamin D deficiency among TED patients was not worse than that of the general Saudi population.
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Affiliation(s)
- Mohammad Alali
- Oculoplastic Division, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | | | - Ahmed Alkhars
- Ophthalmology Department, College of Medicine, King Faisal University, Hofuf, Saudi Arabia
| | - Khadija Albadri
- Oculoplastic Division, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Sultan Al Hassan
- Oculoplastic Division, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
- Ophthalmology Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Mustafa Elewa
- Oculoplastic Division, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Walaa Aldairi
- Ophthalmology Department, College of Medicine, King Faisal University, Hofuf, Saudi Arabia
| | | | | | - Fatimah Alhammad
- Oculoplastic Division, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
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Naik MN, Walvekar P, Vasanthapuram VH, Shankar L. Eyelid Surgery in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2023; 39:S92-S104. [PMID: 38054989 DOI: 10.1097/iop.0000000000002543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE To review and summarize a comprehensive synopsis of surgery of the eyelid in thyroid eye disease (TED). METHODS A PubMed search for specific eyelid manifestations of TED was performed. Studies reporting surgical management of these were reviewed, along with the author's own experience. RESULTS The most common eyelid manifestations of TED include eyelid retraction, blepharoptosis, entropion, and epiblepharon, with most of them requiring surgical intervention. The correction of eyelid retraction has received maximum attention, with several surgical techniques that have stood the test of time. Blepharoptosis in TED that requires surgical intervention is usually aponeurotic. Entropion and Epiblepharon are rare in TED, and may resolve spontaneously, or following orbital decompression. CONCLUSIONS Retraction is the commonest eyelid manifestation of TED, with multiple surgical options available for its correction. Blepharoptosis, entropion, and epiblepharon are rare eyelid findings in TED, that may occasionally require surgical correction.
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Affiliation(s)
- Milind N Naik
- Hariram Motumal Nasta, and Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
| | - Priyanka Walvekar
- Ophthalmic Plastic Surgery Service, Narayana Nethralaya, Bangalore, India
| | | | - Lekshmy Shankar
- Hariram Motumal Nasta, and Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
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Goel R, Shah S, Gupta S, Khullar T, Singh S, Chhabra M, Khanam S, Kumar S, Sharma P. Alterations in retrobulbar haemodynamics in thyroid eye disease. Eye (Lond) 2023; 37:3682-3690. [PMID: 37221361 PMCID: PMC10686394 DOI: 10.1038/s41433-023-02580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE To study the orbital perfusion parameters of ophthalmic artery (OA) and central retinal artery (CRA) in inactive TED and the changes following surgical decompression. METHODS Non-randomised clinical trial. 24 inactive moderate-to-severe TED orbits of 24 euthyroid cases underwent surgical decompression and examined again at 3 months. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) of OA and CRA were evaluated using colour doppler imaging and normative database was established using 18 healthy controls. RESULTS The mean age was 39.38 ± 12.56 years and male: female ratio was 1: 1.18. Intraocular pressure was higher, and CRA-PSV, CRA-RI, OA-PSV, and OA-EDV were lower in TED in comparison to heathy orbits. The CRA-PSV, CRA-EDV, OA-PSV, and OA-EDV negatively correlated with proptosis and duration of thyroid disease. The area under curve of OA-PSV (95% CI:0.964-1.000, p < 0.001) and OA-EDV (95% CI:0.699-0.905, p < 0.001) helped in differentiating TED orbits from HC, and in predicting the severity of disease. Post decompression, CRA-PSV, CRA-EDV, OA-PSV, and OA-EDV improved, with decrease in CRA-RI and OA-RI in both lipogenic and MO. CONCLUSIONS The orbital perfusion is reduced in inactive TED. The changes in OA flow velocities can help in differentiating inactive TED from healthy orbits and progression of TED. Sequential orbital CDI of OA and CRA can serve as an objective tool for case selection and monitoring response to surgical decompression.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India.
| | - Swati Gupta
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Tamanna Khullar
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Sonam Singh
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Mohit Chhabra
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Samreen Khanam
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Sumit Kumar
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Pankaj Sharma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Li Z, Luo Y, Feng X, Zhang Q, Zhong Q, Weng C, Chen Z, Shen J. Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy. J Magn Reson Imaging 2023; 58:1279-1289. [PMID: 36780178 DOI: 10.1002/jmri.28642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Assessment of the activity of Graves' ophthalmopathy (GO) is difficult. Existing methods need improvement. PURPOSE Investigate the application of multiparametric magnetic resonance imaging (MRI) in GO. STUDY TYPE Retrospective. POPULATION A total of 235 GO patients (age: 38.8 ± 13.4 years; 90 male; 96 active patients). FIELD STRENGTH/SEQUENCE Short-tau inversion recovery (STIR) fast spin echo, multiecho spin echo T2 mapping and 3D T1-weighted fast field echo sequences at 3.0 T. ASSESSMENT Two physicians assessed the mean and maximum signal intensity ratio of extraocular muscles to white matter (SIR), T2 relaxation time (T2RT), extraocular muscle area (EMA), fat fraction (FF), retrobulbar fat volume (RFV), and extraocular muscle volume (EMV). Clinical activity score (CAS) ≧ 3 was in active stage. STATISTICAL TESTS The optimal cut-off point of diagnostic efficacy was selected using receiver operating characteristic (ROC) curve analysis and evaluated using area under the curve (AUC), compared using Student's t test, analysis of variance or Kruskal-Wallis H test. The correlation used Pearson correlation analysis. The discriminant equation used a binary logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS The SIRmean, SIRmax, T2RTmean, T2RTmax, EMA, and EMV in active GO patients were significantly higher than those in inactive and were positively correlated with CAS (r = 0.276, 0.228, 0.438, 0.388, 0.502, and 0333, respectively). The FFmax of active patients was significantly lower than that of inactive patients and was negatively correlated with CAS (r = -0.44). Logistic regression analysis indicated that T2RTmean was independently associated with GO active periods and had good diagnostic performance (area under ROC curve = 0.736, sensitivity 70.7%, specificity 69.3%). T2RTmean ≧ 74.295 could be a diagnostic cut-off for judging GO activity (sensitivity 55.3%). CONCLUSION SIR, T2RT, EMV, and FF can quantitatively assess the activity and severity of GO and can potentially provide a basis for clinical judgment and selection of treatment options. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Zhangfang Li
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yaosheng Luo
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
| | - Xiaoting Feng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qiang Zhong
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chanyan Weng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Shen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
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Ramesh S, Zhang QE, Sharpe J, Penne R, Haller J, Lum F, Lee AY, Lee CS, Pershing S, Miller JW, Lorch A, Hyman L. Thyroid Eye Disease and its Vision-Threatening Manifestations in the Academy IRIS Registry: 2014-2018. Am J Ophthalmol 2023; 253:74-85. [PMID: 37201696 PMCID: PMC10525031 DOI: 10.1016/j.ajo.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE To evaluate prevalence of thyroid eye disease (TED) and associated factors in the American Academy of Ophthalmology IRISⓇ Registry (Intelligent Research in Sight). DESIGN Cross-sectional analysis of the IRIS Registry. METHODS IRIS Registry patients (18-90 years old) were classified as TED (ICD-9: 242.00, ICD-10: E05.00 on ≥2 visits) or non-TED cases, and prevalence was estimated. Odds ratios (OR) and 95% Confidence Intervals (CIs) were estimated using logistic regression. RESULTS 41,211 TED patients were identified. TED prevalence was 0.09%, showed a unimodal age distribution (highest prevalence in ages 50-59 years (y) (0.12%)), higher rates in females than males (0.12% vs. 0.04%) and in non-Hispanics than Hispanics (0.10% vs. 0.05%). Prevalence differed by race (from 0.08% in Asians to 0.12% in Black/African-Americans), with varying peak ages of prevalence. Factors associated with TED in multivariate analysis included age: ((18-<30y (reference), 30-39y: OR (95%CI) 2.2 (2.0, 2.4), 40-49y: 2.9 (2.7,3.1), 50-59y: 3.3 (3.1, 3. 5), 60-69y: 2.7 (2.54, 2.85), 70+: 1.5 (1.46, 1.64)); female sex vs male (reference), 3.5 (3.4,3.6), race: White (reference), Blacks: 1.1 (1.1,1.2), Asian: 0.9 (0.8,0.9), Hispanic ethnicity vs not Hispanic (reference), 0.68 (0.6,0.7), smoking status: (never (ref), former: 1.64 (1.6,1.7), current 2.16: (2.1,2.2)) and Type 1 diabetes (yes vs no (reference): 1.87 (1.8, 1.9). CONCLUSIONS This epidemiologic profile of TED includes new observations such as a unimodal age distribution and racial variation in prevalence. Associations with female sex, smoking, and Type 1 diabetes are consistent with prior reports. These findings raise novel questions about TED in different populations.
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Affiliation(s)
- Sathyadeepak Ramesh
- From Department of Oculoplastics and Orbital Surgery, Wills Eye Hospital, Philadelphia, PA, USA (S.R, R.P); The Center for Eye and Facial Plastic Surgery, Somerset, NJ, USA (S.R)
| | - Qiang Ed Zhang
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - James Sharpe
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - Robert Penne
- From Department of Oculoplastics and Orbital Surgery, Wills Eye Hospital, Philadelphia, PA, USA (S.R, R.P)
| | - Julia Haller
- Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA, USA (F.L)
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA (A.Y.L, C.S.L); Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA (A.Y.L, C.S.L)
| | - Suzann Pershing
- Byers Eye Institute, Stanford University, and VA Palo Alto Health Care System, Palo Alto, CA, USA (S.P)
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Alice Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H).
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Eshraghi B, Pourazizi M, Abbasi M, Mohammadbeigy I. A comparison between bilateral and unilateral thyroid eye disease. Int Ophthalmol 2023; 43:2957-2962. [PMID: 37067696 DOI: 10.1007/s10792-023-02702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To compare characteristics of unilateral vs. bilateral thyroid eye disease (TED). METHODS This retrospective analytical cross-sectional study was conducted on patients with TED who were evaluated at an academic referral center over a 6-year period. We compared demographics, activity (clinical activity score) and severity (EUGOGO classification) of TED, thyroid disease duration, TED duration, the time interval between thyroid and eye involvement, thyroid function status, and clinical signs between bilateral and unilateral TED. RESULTS Three hundred eighty-three patients including 213 females (55.6%), who had a mean age of 40.23 ± 13.72 years, were enrolled. Active TED was seen in 8.8% of bilateral and none of unilateral cases (P = 0.04). Bilateral TED patients had more severe disease (P = 0.001). The distribution of hyperthyroidism, hypothyroidism, and euthyroidism was significantly different between unilateral and bilateral groups (P = 0.001). Abnormal ocular motility was present in 26.3% versus 2.3% of bilateral and unilateral ones, respectively (P = 0.001). Proptosis was more prevalent in bilateral than unilateral cases (P = 0.001). We did not observe any statistically significant difference between the two groups in others variables. CONCLUSION Bilateral TED patients present with more severity, activity, movement abnormality, proptosis, and hyperthyroidism.
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Affiliation(s)
- Bahram Eshraghi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Abbasi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Mohammadbeigy
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Ozturk M, Konuk O, Tarlan B, Yalcın MM, Arıbas YK, Toruner FB, Unal M, Ayvaz G. Clinical characteristics and the treatment modalities of Graves' orbitopathy in a tertiary referral center in Turkey: changes over two decades. Int Ophthalmol 2023; 43:643-653. [PMID: 36030455 DOI: 10.1007/s10792-022-02468-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the changes in demographics, clinical findings, and treatment modalities in Graves' orbitopathy (GO) patients at a tertiary referral center in Turkey over the last two decades. METHODS The clinical data of 752 GO patients were evaluated retrospectively. Patients were divided into 2 groups according to the first ophthalmic examination date; Group 1(n:344) between January 1998 and December 2007 and Group 2(n:408) between January 2008 and December 2017. RESULTS The number of nonsmokers was significantly higher in Group 2 (44.0 vs. 26.5%, p < 0.001). The time from the diagnosis of thyroid dysfunction and referral to our center was 32.4 months in Group 1 and 34.8 months in Group 2, (p = 0.166). The most common treatment of hyperthyroidism was antithyroid medications. Radioiodine ablation treatment rate was significantly lower in Group 2 (14.8 vs. 9.1%, p < 0.001). The time between the diagnosis of thyroid disease and orbital involvement was 22.0 vs. 26.6 months in Groups 1 and 2, respectively (p = 0.009). The time elapsed between the diagnosis of orbital disease and referral to our clinic was 21.0 months vs. 22.4 months in Group 1 and 2, respectively (p = 0.068). Orbital disease was most commonly mild, and inactive. Mild and moderate to severe GO and the mean Clinical Activity Score significantly increased, and the rate of sight-threatening disease and orbital decompression surgery significantly decreased in Group 2 (p = 0.042; p < 0.001, respectively). CONCLUSIONS Mild and inactive orbital disease was the most common form of GO. The severity of GO is declining over the last two decades in Turkey.
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Affiliation(s)
- Mine Ozturk
- Department of Ophthalmology, Haseki Training and Research Hospital, University of Health Sciences, Millet Street, 34096, Istanbul, Turkey.
| | - Onur Konuk
- Department of Ophthalmology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bercin Tarlan
- Department of Ophthalmology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Muhittin Yalcın
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Yavuz Kemal Arıbas
- Department of Ophthalmology, Gaziantep Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Unal
- Ophthalmology, Private Practice, Ankara, Turkey
| | - Goksun Ayvaz
- Endocrinology and Metabolism, Private Practice, Ankara, Turkey
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Hwang B, Heo H, Lambert SR. Risk Factors for Reoperation after Strabismus Surgery among Patients with Thyroid Eye Disease. Am J Ophthalmol 2022; 238:10-15. [PMID: 34843685 PMCID: PMC9135959 DOI: 10.1016/j.ajo.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine risk factors for strabismus surgery reoperation in patients with thyroid eye disease (TED). DESIGN Retrospective cohort study. METHODS An insurance claims database was used to identify patients with TED who underwent at least one strabismus operation between 2003 and 2019. We recorded specific muscles operated on, as well as the timing and frequency of reoperations. Cox regressions were used to estimate associations between time to reoperation and patient and primary surgery characteristics. RESULTS Of the 448 patients who met inclusion criteria, 111 (24.8%) underwent a reoperation. Patients were followed for an average of 5.4 ± 3.0 years after their initial strabismus surgery. The rates of reoperation among patients whose initial surgery involved horizontal muscles only, vertical muscles only, and horizontal and vertical muscles were 29 of 120 (24.2%), 33 of 169 (19.5%), and 49 of 159 (30.8%) respectively (P = .05). The number of muscles operated on initially was the only independent predictor for undergoing a strabismus surgery reoperation (odds ratio, 1.27; 95% confidence interval, 1.03-1.57; P = .03). The number of muscles operated on initially was also associated with shorter time to first reoperation (hazard ratio, 1.22; 95% confidence interval, 1.02-1.46; P = .03). Age at first surgery, time between diagnosis of TED and first strabismus surgery, gender, race, and use of adjustable sutures were not associated with time to reoperation. CONCLUSIONS Approximately 1 in 4 patients with TED require reoperation after strabismus surgery. The number of muscles operated on was the only independent predictor for both undergoing a reoperation and time to first reoperation.
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Affiliation(s)
- Bryce Hwang
- From the Department of Ophthalmology, Stanford University School of Medicine (B.H., H.H., S.R.L.), Palo Alto, California, USA
| | - Hwan Heo
- From the Department of Ophthalmology, Stanford University School of Medicine (B.H., H.H., S.R.L.), Palo Alto, California, USA; and the Department of Ophthalmology, Chonnam National University Medical School and Hospital (H.H.), Gwangju, Republic of Korea
| | - Scott R Lambert
- From the Department of Ophthalmology, Stanford University School of Medicine (B.H., H.H., S.R.L.), Palo Alto, California, USA.
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Chung HW, Lee H, Baek S. Absent Bell's phenomenon in patients with thyroid eye disease. BMC Ophthalmol 2021; 21:361. [PMID: 34635084 PMCID: PMC8507383 DOI: 10.1186/s12886-021-02107-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the incidence of absent Bell’s phenomenon (BP) and the relationship between absent BP and inferior rectus muscle hypertrophy and other clinical features in patients with thyroid eye disease (TED). Methods A total of 104 patients who were first diagnosed with TED between January and December 2014 were included. Inferior rectus muscle area and associations with clinical features of TED and thyroid function test including thyroid specific antibodies were compared between patients with TED with and without BP. The volume of the inferior rectus muscle was calculated by adding up all the cross-sectional areas measured on sagittal CT images. Results Among the 104 patients, 14 had absent BP (13.5%), 12 with bilateral and two with unilateral. There was no significant difference in thyroid function test, presence of TSIs, exophthalmos, or volume of inferior rectus muscle measured in CT scans (P > 0.05). Incidence of diplopia, elevation limitation, and upper eyelid retraction were risk factors of absent BP in TED patients (by logistic regression analysis, P < 0.05). Conclusions Inferior rectus muscle hypertrophy was not the cause of absent BP in TED patients. Fibrosis and tightening of the inferior rectus muscle, lower eyelid, and surrounding orbital tissues, rather than inferior rectus muscle hypertrophy, might be related to absent BP in TED patients.
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Affiliation(s)
- Hyun Woo Chung
- Department of Ophthalmology, Ansan Hospital, Korea University College of Medicine, 123 Jeokkumro, Ansan-shi, Kyunggi-do, 15355, Republic of Korea.,Department of Ophthalmology, Guro Hospital, Korea University College of Medicine, 148 Gurodongro, Seoul, 08308, Republic of Korea
| | - Hwa Lee
- Department of Ophthalmology, Ansan Hospital, Korea University College of Medicine, 123 Jeokkumro, Ansan-shi, Kyunggi-do, 15355, Republic of Korea.
| | - Sehyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
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Vasanthapuram VH, Naik MN. Blepharoptosis in thyroid eye disease: etiopathogenesis, clinical features and correlation with thyroid eye disease. Int Ophthalmol 2021; 42:13-18. [PMID: 34347224 DOI: 10.1007/s10792-021-01992-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the etiopathogenesis and clinical features of blepharoptosis in patients with thyroid eye disease. METHODS A 10-year retrospective interventional study. The etiopathogenesis, laterality, clinical features, and management of Blepharoptosis in thyroid eye disease (TED) were assessed. RESULTS A total of 1000 patients of TED were evaluated in the 10-year period, of which 55 (5.5%) presented with Blepharoptosis. The average age at presentation was 44.8 years, and 31 (56.4%) were males. Of the 41 cases where referral diagnosis was available, TED was suspected in only 2 cases. Of the 55, 25 patients were inactive (TED duration ≥ 12 months), and 29 were silent presenters (TED duration ≤ 12 months, but clinical activity score ≤ 3). Ptosis was the primary presenting symptom in 14 cases. Ptosis was aponeurotic in 38 cases, myasthenic in 13 cases, congenital in 2 cases, and indeterminate in 2 cases. Orbital imaging was available in 26 cases, of which fat disease was noted in 14 cases. Average amount of ptosis was 2.21 mm (range 1-6 mm). Lower eyelid retraction (average 2.1 mm) was noted in 49 patients. Surgical management was performed in 10 patients, of which 4 underwent a unique combined surgery (orbital decompression with levator reattachment/resection). CONCLUSIONS In patients with TED, blepharoptosis constitutes 5.5% at presentation to a tertiary eye care centre. Blepharoptosis masks upper eyelid retraction as a clinical sign of TED. Commonest cause was acquired aponeurotic ptosis. A combined levator surgery is possible with orbital decompression in such cases.
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Affiliation(s)
| | - Milind N Naik
- Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India.
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Abstract
Purpose: To report the clinical features, ultrasound biomicroscopic features, and management outcome in patients presenting with thyroid eye disease (TED) and lower eyelid entropion. Methods: Retrospective interventional case review of patients with TED presenting with lower eyelid entropion over a 12-year period.Results: Five patients (eight eyes) of a total of 1211 presented with lower eyelid entropion as one of the presenting signs of TED (0.41%). The average age was 28.8 years (18-39 years), and three patients were males. Three had systemic hyperthyroidism, and two were euthyroid. Four (80%) had bilateral TED, three had inactive disease, and two were active. The average Hertel exophthalmometry reading was 24.6 mm. All patients had upper lid retraction. Four (80%) had concomitant lower eyelid retraction. Entropion was medial in five and complete in three eyes. Symptomatic corneal epitheliopathy was noted in four eyes. UBM was performed in four eyes which showed a thickened middle lamella. In four eyes (three patients), the entropion was managed conservatively as the patient was not contemplating surgery for proptosis. In the remaining four eyes (two patients) orbital decompression was performed and the lower eyelid retractor release corrected the symptomatic entropion. The average follow-up was 11.6 months (range 1-30).Conclusion: Lower eyelid entropion is a rare presenting sign in TED. The mechanism is multifactorial and could be caused by the thickened and fibrosed lower lid retractors, as demonstrated by UBM. Young age and globe projection may play a role. Decompression approaches that involve lower lid retractor release correct the entropion.
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Affiliation(s)
| | - Milind N Naik
- Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
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Gumińska M, Goś R, Śmigielski J, Nowak MS. Topical Treatment of Elevated Intraocular Pressure in Patients with Graves' Orbitopathy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249331. [PMID: 33322192 PMCID: PMC7763944 DOI: 10.3390/ijerph17249331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/11/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022]
Abstract
Purpose: In this study, we evaluated the efficacy of topical hypotensive treatment and/or systemic corticosteroids therapy in patients with elevated intraocular pressure and Graves’ orbitopathy (GO). Methods: We included 172 eyes in 86 individuals with duration of GO ≥ 3 months, intraocular pressure in either eye ≥ 25.0 mmHg, and GO ranked ≥ 3 at least in one eye in modified CAS form. The study subjects were divided into three treatment subgroups: subgroup I was administered latanoprost once a day; subgroup II was administered a combined preparation of brimonidine and timolol BID; subgroup III was the control group, not receiving any topical hypotensive treatment. All the study participants received systemic treatment, intravenous corticosteroid therapy at the same dose, according to the European Group of Graves’ Orbitopathy (EUGOGO) guideline. Results: On the final visit, the mean IOP value was significantly lower in all treatment subgroups compared to the initial values. In both subgroups receiving topical treatment, the IOP reduction was higher than in the control group receiving systemic corticosteroids only. However, the latanoprost eye drops decreased intraocular pressure more effectively than drops containing brimonidine and timolol. Conclusion: Topical ocular hypotensive treatment is effective in reducing intraocular pressure in GO and decreases intraocular pressure more effectively than systemic corticosteroid therapy alone.
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Affiliation(s)
| | - Roman Goś
- Department of Ophthalmology and Visual Rehabilitation, Central Veterans Hospital, Medical University of Lodz, 113 Zeromskiego str., 90-549 Lodz, Poland;
| | - Janusz Śmigielski
- Department of Statistics, State University of Applied Science in Konin, 1 Przyjazni str., 65-510 Konin, Poland;
| | - Michał S. Nowak
- Provisus Eye Clinic, 112 Redzinska str., 42-209 Częstochowa, Poland;
- Saint Family Hospital Medical Center, 19 Wigury str., 90-302 Lodz, Poland
- Correspondence: ; Tel.: +48-888-801010
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Abstract
Graves' Orbitopathy (GO) is an autoimmune orbital disorder usually presenting as a sequala of autoimmune thyroid disease. The presence of GO is associated with increased psychological burden and, in severe cases may cause blindness. While most patients with GO present with bilateral disease, asymmetric or unilateral GO may affect a significant proportion of patients diagnosed with GO. Older age, male sex, active and severe disease correlate with asymmetric disease. However, the exact mechanisms causing asymmetry remain elusive. Herein, we review the literature on asymmetric GO and highlight its differences compared with bilateral GO.
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Affiliation(s)
- Grigorios Panagiotou
- Department of Acute and Intensive Care Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, United Kingdom
- *Correspondence: Grigorios Panagiotou,
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
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