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Soleymanzadeh M, Rafizadeh SM, Ghochani G, Mafi AR, Nazari M, Rajabi MT. Biomechanical changes of the cornea after orbital decompression in thyroid-associated orbitopathy measured by corvis ST. Sci Rep 2024; 14:16930. [PMID: 39043930 PMCID: PMC11266539 DOI: 10.1038/s41598-024-68081-8] [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: 05/28/2024] [Accepted: 07/19/2024] [Indexed: 07/25/2024] Open
Abstract
This study aims to investigate the changes in ocular biomechanical factors in patients with inactive thyroid eye disease (TED) who undergo orbital decompression surgery. This observational prospective study include 46 eyes of 31 patients with inactive TED undergoing orbital decompression at a tertiary university hospital from October 2021 to September 2023. All participants underwent a full ophthalmic examination, and a biomechanical examination was performed using corvis ST at baseline, 1 month, and 3 months postoperatively. The study participants had a mean age of 45 ± 11.6 years, and 58.1% of them were female. The second applanation time (A2T) increased from baseline to postoperative month 1 and continued to increase to postoperative month 3 (P < 0.001). The first applanation velocity (A1V), highest concavity (HC) peak distance, and pachymetry parameters also increased from postoperative month 1 to postoperative month 3 (P = 0.035, P = 0.005, and P = 0.031, respectively). The HC time increased from baseline to postoperative month 3 (P = 0.027). Other changes were statistically insignificant. The P-values were adjusted according to biomechanically corrected intraocular pressure (bIOP). Baseline Hertel significantly influenced A2 time (P < 0.001). Our findings suggest that ocular biomechanical parameters may change following decompression surgery in patients with inactive TED. Specifically, an increase in A2T, A1V, and HC peak distance suggests a decrease in corneal stiffness, although the increased HC time contradicts this. It is recommended to postpone keratorefractive or intraocular lens implantation surgeries until corneal biomechanics stabilize after decompression surgery for optimal results.
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Affiliation(s)
- Mahdi Soleymanzadeh
- Department of Oculo-Facial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Seyed Mohsen Rafizadeh
- Department of Oculo-Facial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran.
| | - Ghazal Ghochani
- Department of Oculo-Facial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Amir Reza Mafi
- Department of Oculo-Facial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Mohammadreza Nazari
- Department of Oculo-Facial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Mohammad Taher Rajabi
- Department of Oculo-Facial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
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Chuephanich P, Kitsirilarp W, Keorochana N. Characteristics, Etiologies, and Outcomes of Peripheral Ulcerative Keratitis in a Tertiary Referral Hospital in Thailand: A 10-Year Study. Ocul Immunol Inflamm 2023:1-8. [PMID: 38133946 DOI: 10.1080/09273948.2023.2296069] [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: 06/27/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To evaluate characteristics, etiologies, and outcomes of peripheral ulcerative keratitis (PUK) in Thailand. METHODS Retrospective study. RESULTS Forty-three eyes from 34 patients were enrolled, with a mean age of 53.44 ± 15.48 years. PUK affected women more than men (1.6:1) and resulted in unilateral lesions more frequently than bilateral lesions (2.8:1). Redness (56.3%) was the most common presenting symptom followed by pain (43.8%) and irritation (40.6%). The three most common etiologies were Mooren's ulcer (52.9%), rheumatoid arthritis (20.6%), and Graves' disease (8.8%). Corneal thinning was significantly more common in unilaterality (p = 0.004) and less common when the lesion was located in the superior cornea (p = 0.031). Surgery was also more frequently performed in case of unilateral PUK (p = 0.026). Perforation was observed in 5 eyes (11.6%) and recurrence after treatment was identified in 8 eyes (18.6%). CONCLUSION Nearly half of PUK cases are associated with several systemic causes. Accordingly, careful physical examination and investigation are important. Unilateral lesions could serve as potential risk factors in identifying patients at risk of thinning and perforation, which could prevent further damage to the eye and vision loss.
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Affiliation(s)
- Pichaya Chuephanich
- Department of Ophthalmology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Narumon Keorochana
- Department of Ophthalmology, Phramongkutklao College of Medicine, Bangkok, Thailand
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Chang YM, Weng TH, Tai MC, Lin TY, Chen YH, Chien KH. Corneal topographic changes in patients with thyroid eye disease: A retrospective cross-sectional study. Cont Lens Anterior Eye 2023; 46:101843. [PMID: 37037712 DOI: 10.1016/j.clae.2023.101843] [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: 11/02/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE This study aimed to evaluate corneal topographic findings in patients with thyroid eye disease (TED) using a Galilei camera and compare their corneal topographic parameters with those of control patients. METHODS This retrospective cross-sectional study included 52 eyes of 26 patients with TED (study group) and 40 eyes of 20 controls treated at a tertiary medical center in Taiwan between January and December 2021. All participants underwent basic ophthalmological examinations, corneal topography examination using a Galilei dual Scheimpflug camera, thyroid function examination, and orbital computed tomography. The corneal topographic parameters and cross-sectional area of the extraocular muscles were compared between the TED and control groups. RESULTS Several corneal topographic parameters, including the Inferior-Superior Index, Keratoconus Prediction Index, Surface Asymmetry Index, Surface Regularity Index, simulated keratometry astigmatism, and anterior instantaneous astigmatism axis, differed significantly between the groups (P ≤ 0.05). The anterior instantaneous astigmatism axis was more oblique in the TED group than in the control group. A scatter plot revealed a more scattered distribution in the anterior instantaneous astigmatism axis in the TED group than in the control group. However, the corneal topographic parameters did not differ significantly among the different thyroid dysfunction groups. CONCLUSIONS The corneas of patients with TED are suspicious and keratoconus-like, and TED can increase anterior corneal astigmatism in the oblique axis, albeit with large variations in the extent of change. These TED-related corneal changes may aid in the early diagnosis of TED, especially "silent" TED.
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Affiliation(s)
- Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Hsia Y, Wei YH, Liao SL. The Changes in Ocular Biomechanical Response Parameters and Intraocular Pressure After Surgical Treatment for Thyroid Eye Disease. Invest Ophthalmol Vis Sci 2023; 64:31. [PMID: 37494009 PMCID: PMC10382999 DOI: 10.1167/iovs.64.10.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Purpose To investigate changes in ocular biomechanical response parameters and intraocular pressure (IOP) in patients with thyroid eye disease (TED) undergoing orbital decompression or anterior blepharotomy. Methods Eighty-three eyes from 46 patients receiving orbital decompression (the orbital decompression group) and 45 eyes from 28 patients receiving anterior blepharotomy (the anterior blepharotomy group) were retrospectively enrolled from a tertiary center. Corvis ST tonometry was used to assess ocular biomechanical response and biomechanically corrected IOP (bIOP) pre- and postoperatively. Non-contact tonometry (IOP-NCT) was also performed. Results In the anterior blepharotomy group, the margin reflex distance decreased (P < 0001). The highest concavity radius (P = 0.026) and whole eye movement (P = 0.003) increased. Neither IOP-NCT nor bIOP had a significant change. In the orbital decompression group, the extent of exophthalmos decreased (P < 0.001). The A2 length (P = 0.009) decreased. The bIOP did not show a significant change (16.4 ± 2.7 vs. 16.7 ± 4.5; P = 0.415), but the IOP-NCT decreased significantly (17.5 ± 3.3 vs. 16.0 ± 3.3; P < 0.001). Higher baseline IOP-NCT (β = -0.40, P < 0.001) and greater reduction in stiffness parameter A1 (SP-A1; β = 0.05, P = 0.002) were associated with more significant IOP-NCT reduction after the orbital decompression. Conclusions Ocular biomechanical response parameters may change after TED surgery, potentially affecting IOP measurements, particularly in patients receiving orbital decompression.
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Affiliation(s)
- Yun Hsia
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
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Awad EA, Torky MA, Bassiouny RM, Khattab AM, Elzehery RR, Elhelaly RM. Thyroid gland dysfunction and vitamin D receptor gene polymorphism in keratoconus. Eye (Lond) 2023; 37:1602-1607. [PMID: 35915233 PMCID: PMC10220045 DOI: 10.1038/s41433-022-02172-6] [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: 12/18/2021] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To detect the serum level of thyroid hormones, vitamin D and vitamin D receptors (VDR) polymorphism in keratoconus (KC) patients and to identify the association between vitamin D deficiency and thyroid dysfunction in KC. METHODS This cross sectional study included 177 KC patients with no thyroid disorders compared to 85 healthy controls with normal corneal tomography. Measurements of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetraiodothyronine (FT4) and serum 25-OH vitamin D were done using Enzyme linked immusoassay (ELISA test). VDR polymorphisms were tested including [Taq I (rs731236), Apa I (rs7975232) and Bsm I (rs1544410)] using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS An increase in frequency of thyroid disorders (P = 0.04), decrease in serum 25(OH) vitamin D level (P < 0.001), Taq 1 and tt genotype (P < 0.001) were significantly distributed in KC patients. A significantly higher serum 25(OH) vitamin D level was reported in TT genotype, while insufficient level was more common in Tt genotype (P < 0.001). A deficient serum 25(OH) vitamin D level was predominant in tt genotype (P < 0.001). A 95% confidence interval was in TSH (1.603, 2.946), FT4 (24.145, 77.06), hypothyroidism (1.062, 67.63), insufficient (2.936, 11.643) and deficient vitamin D (5.283, 28.704) and all were significant risk factors for KC with (P < 0.05). CONCLUSIONS Both thyroid disorders and low vitamin D are potential factors for KC development. Studying VDR at the molecular level provides interesting avenues for future research toward the identification of new KC cases.
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Affiliation(s)
- Eman A Awad
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Magda A Torky
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rania M Bassiouny
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abeer M Khattab
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha R Elzehery
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rania M Elhelaly
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Oklar M, Yazicioglu T, Ozen MC, Agackesen A, Gun RD, Tezcan KA. Evaluation of corneal endothelium and correlation with disease severity in patients with Graves' ophthalmopathy: A specular microscopy-based study. Photodiagnosis Photodyn Ther 2023:103592. [PMID: 37146893 DOI: 10.1016/j.pdpdt.2023.103592] [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: 02/26/2023] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To investigate the possible corneal endothelial damage in Graves' ophthalmopathy (GO) and its relationship with GO activity. METHODS This cross-sectional study included 101 eyes of 55 patients with GO. Each eye was assigned a specific clinical activity score (CAS). Accordingly, they were classified as active (CAS ≥ 3) or inactive (CAS< 3). The corneal endothelium was measured using a non-contact specular microscope (Tomey EM-4000; Tomey Corp.). Endothelial cell density (ECD), average cell area (ACA), standard deviation of cell area (SD), coefficient of variation in cell area (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were recorded. RESULTS Among the eyes included in the study, 71 had inactive GO and 30 had active GO. ACA and HEX levels were lower (p<0,001) and CV values were higher (p<0.001) in patients with GO than in healthy subjects. Corneal endothelial cell morphology was altered in active GO compared to inactive GO. The SD (p=0,009) and CV (p<0,001) were significantly higher in active GO than in inactive GO. When the parameters examined were correlated with CAS, a statistically significant positive correlation was observed between proptosis (p=0,036, r=0,385) and CV (p=0,001, r=0,595). CONCLUSION Our study confirmed that morphological changes occur in the corneal endothelium of patients with GO. CV and SD values, in conjunction with CAS, can be used as non-invasive and quantitative indices to examine the activity status of GO. The demonstration of endothelial changes even in GO eyes with low CAS may be considered an incentive to include non-contact specular microscopy in the routine clinical evaluation of all patients with GO.
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Affiliation(s)
- Murat Oklar
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey.
| | - Titap Yazicioglu
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey.
| | - Mehmet Can Ozen
- Department of Ophthalmology, Batman Kozluk State Hospital, Batman, Turkey
| | - Anıl Agackesen
- Department of Ophthalmology, Batman İluh State Hospital, Batman, Turkey
| | - Raziye Donmez Gun
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Kadriye Aydin Tezcan
- Department of Endocrinology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
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Pérez-López M, Ting DSJ, Lanzagorta-Aresti A, Montolio-Marzo S, Davó-Cabrera J, Cid-García I. Influence of corneal biomechanical properties on intraocular pressure measurement in different types of Graves’ orbitopathy. Eur J Ophthalmol 2023; 33:567-573. [PMID: 36062595 DOI: 10.1177/11206721221124655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS To compare the ocular biomechanical properties of inactive Grave's orbitopathy (GO) patients and healthy subjects and to evaluate the influence of severity and phenotype of GO on these parameters. METHODS This was a cross-sectional study. All included inactive GO patients and healthy controls underwent complete ocular examination, including Goldman applanation tonometry (GAT), corneal biomechanical analysis using Ocular Response Analyser (ORA), and corneal epithelial thickness analysis using Optovue. Patients with inactive GO were classified based on the severity and orbital phenotype (predominantly myogenic or lipogenic). Comparison among groups was performed. RESULTS 60 eyes from 30 inactive GO patients and 30 healthy eyes were examined. Corneal hysteresis (CH) was significantly lower in inactive GO patients (9.6 [p25 8.1; p75 11.2]) compared to controls (10.4 [9.8; 11.5]) (p = 0.012). In GO patients, cornea compensated intraocular pressure (IOPcc) was significantly higher than Goldman applanation tonometry IOP (IOP-GAT) (p = 0.001). A total of 13.3% GO patients were initially classified as having ocular hypertension (OHT; defined as IOP > 21 mmHg with no signs of glaucomatous optic neuropathy) based on IOP-GAT measurement. According to IOPcc, 27.8% of GO patients were classified as OHT. In GO patients, no differences were found in corneal bimechanical properties according to the disease severity or orbital phenotype. CONCLUSIONS CH is significantly lower in inactive GO patients compared to healthy subjects. ORA corrected IOP was significantly higher in GO patients compared to IOP-GAT. No differences in corneal biomechanical properties between mild and moderate-to-severe GO disease and between myogenic and lipogenic orbitopathy were found.
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Affiliation(s)
- Marta Pérez-López
- Ophthalmology Department, 16273Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Darren S J Ting
- Academic Ophthalmology, School of Medicine, 6123University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | | | | | - Juan Davó-Cabrera
- Ophthalmology Department, 16273Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Isabel Cid-García
- Ophthalmology Department, 150239Fisabio Oftalmología Médica, Valencia, Spain
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Evaluation of the corneal biomechanical properties and corneal thickness in patients with Graves’ orbitopathy. Int Ophthalmol 2022. [DOI: 10.1007/s10792-022-02621-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Babić Leko M, Pleić N, Lešin M, Gunjača I, Torlak V, Škunca Herman J, Vatavuk Z, Punda A, Polašek O, Hayward C, Zemunik T. Association between Thyroid Function and Ocular Parameters. BIOLOGY 2022; 11:1847. [PMID: 36552356 PMCID: PMC9776046 DOI: 10.3390/biology11121847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
During development, thyroid hormones play an important role in eye development, while in adults, some pathological thyroid conditions can affect the normal functioning of the eyes. Thyroid eye disease is the most well-known eye pathology caused by a pathological thyroid condition. Few studies have investigated the association between ocular parameters and thyroid function. Thus, in this study, we aimed to examine whether thyroid activity affects ocular parameters. This cross-sectional study included 4633 healthy adults recruited within the 10,001 Dalmatians project of the Croatian Biobank. The plasma levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin (Tg), thyroglobulin antibodies (TgAb), and thyroid peroxidase antibodies (TPOAb) were measured by an immunoassay. We determined 20 ocular parameters for each participant (10 for each eye, including corneal radius, corneal thickness, anterior chamber depth, anterior chamber angle, lens thickness, posterior chamber length, axial length, intraocular lens power (IOL), spherical power, and cylinder power). Patients with hyperthyroidism had thicker corneas compared to euthyroid individuals. Corneal thickness was also negatively associated with plasma TSH levels. Intra-ocular lens power was higher in patients with clinical hypothyroidism, while spherical power was higher in euthyroid individuals with positive antibodies compared to euthyroid individuals. Intra-ocular lens power negatively correlated with fT4 levels, while spherical power positively correlated with TgAb, TPOAb, and Tg levels and negatively correlated with TSH levels. The anterior chamber angle was positively associated with plasma TSH levels and TPOAb levels and negatively associated with plasma fT4 levels. These findings suggest an interesting interplay between ophthalmic measures and thyroid status, detectable even in the general adult population.
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Affiliation(s)
- Mirjana Babić Leko
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Nikolina Pleić
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Mladen Lešin
- Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia
| | - Ivana Gunjača
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Vesela Torlak
- Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia
| | - Jelena Škunca Herman
- Department of Ophthalmology, Clinical Hospital Sisters of Mercy, 10000 Zagreb, Croatia
| | - Zoran Vatavuk
- Department of Ophthalmology, Clinical Hospital Sisters of Mercy, 10000 Zagreb, Croatia
| | - Ante Punda
- Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia
| | - Ozren Polašek
- Department of Public Health, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
- Algebra University College, 10000 Zagreb, Croatia
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Tatijana Zemunik
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
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Razeghinejad MR, Farsiani AR, Salout R, Owji N, Masoumpour M, Kharmandar A, Zamani M. Corneal biomechanical properties in hyperthyroidism and thyroid eye disease. Saudi J Ophthalmol 2021; 34:251-255. [PMID: 34527867 PMCID: PMC8409357 DOI: 10.4103/1319-4534.322605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE: The purpose of this study is to compare the corneal biomechanical properties of hyperthyroids without ophthalmopathy (HWO), thyroid eye disease (TED), and euthyroid participants. METHODS: In this prospective comparative study, one eye per patient included in the analysis and according to exclusion criteria, 38 eyes of 40 HWO patients, 31 eyes of 40 TED patients, and 150 eyes of 160 age- and sex-matched euthyroid participants were enrolled. All participants were evaluated by an endocrinologist and oculoplastic surgeon for evaluation of thyroid function and orbitopathy, respectively. Measurements of corneal biomechanical properties were performed using ocular response analyzer and Corvis ST tonometers. RESULTS: In the HWO group, applanation-1 length (A1 L), applanation-2 velocity (A2V) (P < 0.001), and corneal resistant factor (P = 0.043) were higher than the control group and corneal hysteresis (CH) was lower (P = 0.018). In the TED group, A1 L, A2V (P < 0.001), and highest concavity radius (HCR) (P = 0.027) were higher than the control group, and the CH (P = 0.007) and highest concavity deformation amplitude (HCDA) (P = 0.001) were lower. Furthermore, the level HCDA in the TED group was lower than HWO group (P = 0.011). The level of upper scleral show and palpebral fissure had a negative correlation with CH and HCDA. The amount of exophthalmos level had a positive correlation with HCR. CONCLUSION: Corneal biomechanical properties in the HWO and TED groups were different from the normal euthyroid individuals and may be taken into account in managing situation like glaucoma and refractive surgeries.
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Affiliation(s)
- M Reza Razeghinejad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Amir R Farsiani
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Ophthalmology, School of Medicine, Zanjan University of Medical sciences, Zanjan, Iran
| | - Ramin Salout
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Salouti Eye Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - Naser Owji
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Masoumpour
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Kharmandar
- Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zamani
- Salouti Eye Research Center, Salouti Eye Clinic, Shiraz, Iran
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Bassiouny RM, Awad EA, Gaafar W, Kyrillos FA, Abou Samra WA, Abdelhameed AG. Corneal Tomographic Analysis Among Patients With Thyroid Gland Dysfunction. J Refract Surg 2021; 37:192-197. [PMID: 34038304 DOI: 10.3928/1081597x-20210105-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the corneal tomographic parameters of patients with thyroid gland dysfunction. METHODS This case-control study included 100 eyes of 50 patients with thyroid gland dysfunction and 100 eyes of 50 healthy controls. All eyes were examined by Pentacam (Oculus Optikgeräte GmbH). Pentacam parameters were compared between patients with thyroid gland dysfunction and controls. Spearman's correlation coefficient between different Pentacam parameters and the serum level of free thyroxin (T4) and thyroid-stimulating hormone (TSH) was calculated. RESULTS Patients with hypothyroidism had significantly higher median values of steep and maximum simulated keratometric readings, central corneal thickness (CCT), and thinnest pachymetry (CTmin) than both patients with hyperthyroidism and controls (P⩽ .05). The median values of the average and maximum pachymetric progression index (PPI), posterior elevation, and back difference elevation were significantly higher in patients with hyperthyroidism than in patients with hypothyroidism and controls (P ⩽ .05). The Ambrósio Relational Thickness (ARTmax) was significantly reduced in patients with hyperthyroidism (P ⩽ .001). Both CCT and CTmin showed a moderately positive correlation with serum TSH level and a moderately negative correlation with serum free T4 level. Patients with non-autoimmune thyroid gland dysfunction had significantly thinner CCT, CTmin, and inferior vertical deviation than the autoimmune group (P ⩽ .05). CONCLUSIONS Thyroid gland dysfunction is associated with significant corneal tomographic changes. Patients with hyperthyroidism tend to have thinner corneas and more abnormal tomographic parameters correlating with keratoconus. No significant tomographic changes were found in association with autoimmune thyroid gland dysfunction. The authors recommend screening and regular follow-up of patients with thyroid gland dysfunction for early detection and management of keratoconus. [J Refract Surg. 2021;37(3):192-197.].
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Sun R, Zhou HF, Fan XQ. Ocular surface changes in Graves' ophthalmopathy. Int J Ophthalmol 2021; 14:616-621. [PMID: 33875956 DOI: 10.18240/ijo.2021.04.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023] Open
Abstract
Many patients with Graves' ophthalmopathy (GO) suffer from dry eye syndrome (DES), and this is one of the most common reasons of eye discomfort in patients with GO. The prevalence of DES in patients with GO is significantly higher than normal subjects. The ocular surface changes involving changes in tears, cornea, conjunctiva and glands occur in GO patients. However, the mechanism of how DES occurs in GO still remains unclear. In this review, the ocular surface changes were illustrated and analyzed the reasons for high prevalence of DES in GO patients.
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Affiliation(s)
- Rou Sun
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Hui-Fang Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xian-Qun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Shah R, Amador C, Tormanen K, Ghiam S, Saghizadeh M, Arumugaswami V, Kumar A, Kramerov AA, Ljubimov AV. Systemic diseases and the cornea. Exp Eye Res 2021; 204:108455. [PMID: 33485845 PMCID: PMC7946758 DOI: 10.1016/j.exer.2021.108455] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
There is a number of systemic diseases affecting the cornea. These include endocrine disorders (diabetes, Graves' disease, Addison's disease, hyperparathyroidism), infections with viruses (SARS-CoV-2, herpes simplex, varicella zoster, HTLV-1, Epstein-Barr virus) and bacteria (tuberculosis, syphilis and Pseudomonas aeruginosa), autoimmune and inflammatory diseases (rheumatoid arthritis, Sjögren's syndrome, lupus erythematosus, gout, atopic and vernal keratoconjunctivitis, multiple sclerosis, granulomatosis with polyangiitis, sarcoidosis, Cogan's syndrome, immunobullous diseases), corneal deposit disorders (Wilson's disease, cystinosis, Fabry disease, Meretoja's syndrome, mucopolysaccharidosis, hyperlipoproteinemia), and genetic disorders (aniridia, Ehlers-Danlos syndromes, Marfan syndrome). Corneal manifestations often provide an insight to underlying systemic diseases and can act as the first indicator of an undiagnosed systemic condition. Routine eye exams can bring attention to potentially life-threatening illnesses. In this review, we provide a fairly detailed overview of the pathologic changes in the cornea described in various systemic diseases and also discuss underlying molecular mechanisms, as well as current and emerging treatments.
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Affiliation(s)
- Ruchi Shah
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Cynthia Amador
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kati Tormanen
- Center for Neurobiology and Vaccine Development, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Ghiam
- Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Mehrnoosh Saghizadeh
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vaithi Arumugaswami
- Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Andrei A Kramerov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander V Ljubimov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Pandey N, Kaur Chhabra A. Evaluation of corneal biomechanical properties on ocular response analyzer and their correlation with the clinical profile of the patients with thyroid-associated ophthalmopathy. Orbit 2020; 40:193-198. [PMID: 32515628 DOI: 10.1080/01676830.2020.1772316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The study evaluates the corneal biomechanical properties on Ocular Response Analyzer (ORA) and aims to establish their correlation with the clinical profile of patients with TAO.Methods: A tertiary care centre-based cross-sectional observational study was conducted. Eighty patients with stage I and II TAO (EUGOGO classification), categorized as group A, were age and sex matched with 85 controls constituting group B. The disease activity was assessed using clinical activity score (CAS). The thyroid hormonal profile of within one-week duration was recorded for each patient of group A. Mean IOP-GAT (IOP using Goldmann applanation tonometer), IOPg (Goldmann-correlated IOP value), IOPcc (cornea-compensated IOP value), CRF (corneal resistance factor), and mean corneal hysteresis (CH) of group A and B were compared. The variation of CH with disease severity, activity, and thyroid status in group A was evaluated.Results: Mean GAT, IOPg, and IOPcc of group A were significantly higher than that of group B (p < .001). Mean CH of group A i.e the visco-elastic dampening ability of cornea was significantly lower than that of group B (p < .001). In group A, mean CH of patients with stage 1 disease severity and CAS<3 was significantly higher than that of patients with stage 2 severity and CAS≥3 (p < .001). CH of hyperthyroid patients was significantly lower than CH of hypothyroid patients (p < .01).Conclusion: TAO affects the biomechanical properties of the globe as reflected by the corneal biomechanics on ORA. The disease severity, activity, and hyperthyroid status are negatively correlated with the CH.
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Affiliation(s)
- Nitika Pandey
- Department of Ophthalmology, King George's Medical University, Lucknow, India
| | - Apjit Kaur Chhabra
- Department of Ophthalmology, King George's Medical University, Lucknow, India
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Ozturk Karabulut G, Fazil K, Ozturker C, Gunaydin ZK, Altan C, İnal A, Taskapili M, Kaynak P. Do ocular pulse amplitude and choroidal thickness change in patients with thyroid eye disease? Orbit 2019; 38:347-352. [PMID: 30335539 DOI: 10.1080/01676830.2018.1533568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 09/30/2018] [Indexed: 06/08/2023]
Abstract
Purpose: The aim of this study was to evaluate whether orbital changes induced by thyroid eye disease affect the ocular pulse amplitude and choroidal perfusion. Materials and Methods: A total of 38 eyes of 38 patients with thyroid eye disease (Group 1) and 38 eyes of 38 control individuals (Group 2) with normal intraocular pressure were enrolled in this study. Thyroid eye disease activity was defined using clinical activity score. Intraocular pressure measurement with Goldmann applanation tonometer, axial length, central corneal thickness, Hertel exophthalmometry and systolic and diastolic blood pressure measurements were taken from each patient. Ocular pulse amplitude and intraocular pressure were measured using dynamic contour tonometry. Choroidal thickness was measured by enhanced depth imaging-optical coherence tomography at subfoveal, nasal and temporal 1000 μm area. Results: Intraocular pressures measured with Goldmann applanation tonometer and dynamic contour tonometry and mean ocular pulse amplitude were not statistically different between groups. However mean choroidal thicknesses were significantly lower when compared to control group. Ocular pulse amplitude and intraocular pressure measurement with dynamic contour tonometry did not change significantly with the increase in clinical activity score. There was not statistically significant correlation between ocular pulse amplitude and choroidal thicknesses in patients with thyroid eye disease. Conclusion: Ocular pulse amplitude and choroidal perfusion were not found to change with orbital involvement in thyroid eye disease and with disease activity, especially in patients with normal intraocular pressure. Although choroidal thickness was thinner than control group, choroidal perfusion did not change as a compensatory mechanism for maintaining ocular homeostasis.
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Affiliation(s)
- Gamze Ozturk Karabulut
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
| | - Korhan Fazil
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
| | - Can Ozturker
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
| | - Zehra Karaağaç Gunaydin
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
| | - Cigdem Altan
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
| | - Asli İnal
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
| | - Muhittin Taskapili
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
| | - Pelin Kaynak
- Ophthalmic Plastic and Reconstructive Surgery Department, University of Health Sciences, Istanbul Beyoglu Eye Research and Training Hospital , Istanbul , Turkey
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Zhang B, Shweikh Y, Khawaja AP, Gallacher J, Bauermeister S, Foster PJ. Associations with Corneal Hysteresis in a Population Cohort: Results from 96 010 UK Biobank Participants. Ophthalmology 2019; 126:1500-1510. [PMID: 31471087 DOI: 10.1016/j.ophtha.2019.06.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/07/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To describe the distribution of corneal hysteresis (CH) in a large cohort and explore its associated factors and possible clinical applications. DESIGN Cross-sectional study within the UK Biobank, a large cohort study in the United Kingdom. PARTICIPANTS We analyzed CH data from 93 345 eligible participants in the UK Biobank cohort, aged 40 to 69 years. METHODS All analyses were performed using left eye data. Linear regression models were used to evaluate associations between CH and demographic, lifestyle, ocular, and systemic variables. Piecewise logistic regression models were used to explore the relationship between self-reported glaucoma and CH. MAIN OUTCOME MEASURES Corneal hysteresis (mmHg). RESULTS The mean CH was 10.6 mmHg (10.4 mmHg in male and 10.8 mmHg in female participants). After adjusting for covariables, CH was significantly negatively associated with male sex, age, black ethnicity, self-reported glaucoma, diastolic blood pressure, and height. Corneal hysteresis was significantly positively associated with smoking, hyperopia, diabetes, systemic lupus erythematosus (SLE), greater deprivation (Townsend index), and Goldmann-correlated intraocular pressure (IOPg). Self-reported glaucoma and CH were significantly associated when CH was less than 10.1 mmHg (odds ratio, 0.86; 95% confidence interval, 0.79-0.94 per mmHg CH increase) after adjusting for covariables. When CH exceeded 10.1 mmHg, there was no significant association between CH and self-reported glaucoma. CONCLUSIONS In our analyses, CH was significantly associated with factors including age, sex, and ethnicity, which should be taken into account when interpreting CH values. In our cohort, lower CH was significantly associated with a higher prevalence of self-reported glaucoma when CH was less than 10.1 mmHg. Corneal hysteresis may serve as a biomarker aiding glaucoma case detection.
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Affiliation(s)
- Bing Zhang
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Yusrah Shweikh
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Anthony P Khawaja
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Paul J Foster
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom.
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The Effect of Strabismus Muscle Surgery on Corneal Biomechanics. J Ophthalmol 2018; 2018:8072140. [PMID: 30305960 PMCID: PMC6165609 DOI: 10.1155/2018/8072140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose Studying the early effect of different extraocular muscle (EOM) surgeries on corneal biomechanics. Subjects and methods This is a prospective, nonrandomized, interventional study, in which 42 eyes of 29 candidates for EOM surgery for strabismus correction at Cairo university hospitals, aged 14–37 years, were recruited. All participants had measuring of the visual acuity, refraction (spherical equivalent (SE)), assessment of the EOM motility and muscle balance, sensory evaluation, fundus examination, and assessing the ocular biomechanics using the Ocular response analyzer (ORA, Reichert, INC., Depew, NY) noting the corneal hysteresis (CH) and corneal resistance factor (CRF) preoperatively. Same patients were reassessed using ORA 4 weeks postoperatively following a different standard EOM surgery (recti weakening/strengthening and inferior oblique weakening either (graded recession) according to the surgical indication, and ∆CH and ∆CRF were calculated, each is the preoperative − the postoperative value. Results ∆CH and ∆CRF = −0.78 ± 1.56 and −0.72 ± 2.15, respectively, and a highly significant difference was found between each of the pre- and postoperative CH and CRF (p < 0.001). 18 eyes had single EOM surgery, while 24 had multiple (2 or 3) EOM surgery; ∆CH in the single group = −1.28 ± 1.5, and ∆CH in the multiple group = 0.4 ± 1.49 (p=0.07). 23 eyes had EOM weakening surgery, while 18 had combined weakening and strengthening EOM surgery: ∆CH in the weakening group = −1.24 ± 1.77 and ∆CH in combined group = −0.26 ± 1.07 (p=0.04). A nonsignificant difference was found for ∆CRF (p=0.53). Conclusion A different EOM surgery has an early tendency for increase of the postoperative CH specially for muscle weakening procedures (recti recession/inferior oblique muscle weakening).
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