Choroidal structural evaluation in inactive Graves' ophthalmopathy

Effect of orbital decompression surgery on the choroidal profile in patients with thyroid eye disease

This study aimed to investigate the effect of orbital wall decompression surgery and reduction of proptosis on the choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) in patients with thyroid eye disease (TED). Fifty-one eyes from 38 patients with controlled TED and proptosis were enrolled in this study. The majority of the patients (50.9%) had a clinical activity score (CAS) of zero, and none had a CAS greater than 2. The patients underwent a complete baseline ophthalmologic examination, and their choroidal profile alterations were monitored using enhanced depth imaging optical coherence tomography (EDI-OCT) before and during the three months after surgery. Changes in SFCT, luminance area (LA), total choroidal area (TCA), and the choroidal vascularity index (CVI) were measured as the ratio of LA to TCA in EDI-OCT images. The participants had an average age of 46.47 years, and 22 were female (57.9%). The SFCT of the patients exhibited a significant reduction over the follow-up period, decreasing from 388 ± 103 to 355 ± 95 µm in the first month (p < 0.001) and further decreasing to 342 ± 109 µm by the third month compared to baseline (p < 0.001). The CVI exhibited a drop from 0.685 ± 0.037 at baseline to 0.682 ± 0.035 and 0.675 ± 0.030 at 1 and 3 months post-surgery, respectively. However, these changes were not statistically significant, indicating comparable decreases in both LA and TCA. There was a significant correlation between improved proptosis and reduction in SFCT (p < 0.001) but not with CVI (p = 0.171). In conclusion, during the three months of follow-up following orbital wall decompression, CVI did not change, while SFCT reduced significantly. Additionally, SFCT was significantly correlated with proptosis reduction, whereas CVI was not.

Changes in choroidal thickness and choroidal vascularity index in thyroid eye disease: a systematic review

PURPOSE

To evaluate the evidence for changes in choroidal thickness and choroidal vascularity index (CVI) in people with thyroid eye disease (TED), stratified by severity, as measured by optical coherence tomography (OCT).

METHODS

Systematic review, including quality assessment, of published studies investigating choroidal thickness in TED. Outcomes of interest included CVI, subfoveal choroidal thickness, mean choroidal thickness, and peripheral choroidal thickness in four quadrants (superior, inferior, medial, lateral).

RESULTS

Nineteen studies were included which contained measurements from 1067 eyes in 798 patients with TED. Most studies found an increased CVI and increased choroidal thickness in patients with TED compared to normal controls, especially in the subfoveal region. In addition, several studies reported an increased thickness in patients with active vs. inactive TED, although the results are equivocal. Finally, many studies reported associations between increased choroidal thickness and worsened clinical measurements of disease activity, such as Clinical Activity Score (CAS).

CONCLUSIONS

This systematic review provided evidence for an association between increased CVI/choroidal thickness and TED, suggesting a potential for OCT-measured CVI/choroidal thickness as an objective clinical marker. Given heterogeneity, future studies are needed to assess the role of measuring the choroidal changes in diagnosis and management of TED.

The Relationship between Choroidal Thickness and Liver Damage in Simple Auto-immune Hepatitis Patients

BACKGROUND

There was no sufficient clinical evidence on the relationship between auto-immune hepatitis (AIH) and risk of eye illness, except 11 uveitis cases where related AIH is reported currently.

AIM

To determine the relationship between choroidal thickness (ChT) and liver damage in simple AIH patients without ocular symptoms after oral prednisone treatment.

PATIENTS AND METHODS

This prospective observational study included simple AIH patients. The patients' ChT was measured by swept-source (SS)-optical coherence tomography (OCT), and the liver damage was evaluated by alanine aminotransferase (ALT) and aspartate aminotransferase (AST). ChT and liver functions were assessed prior to and after treatment. Then comparisons were made prior to and post treatment. The relationships between biochemical indexes of liver injury and ChT were evaluated after a mean (SD) of 24 (1.28) weeks of regular oral prednisone.

RESULTS

A total of 35 patients (31 females, aged 45.66 ± 11.62 years) were included. After treatment, ChT was significantly increased in all sectors (including the center sector, superior inner sector, inner nasal sector, inferior inner sector, inner temporal sector, superior outer sector, outer nasal sector, inferior outer sector, and outer temporal sector) (all P < 0.001). After treatment, both ALT (51.34 ± 44.16 vs 255.06 ± 107.84, P < 0.001) and AST (38.66 ± 27.12 vs 164.89 ± 85.58, P < 0.001) were significantly decreased. The increase of ChT in all sectors was significantly related to the decrease of ALT and AST (all P < 0.001).

CONCLUSION

The improvement of ChT might reflect the remission of liver damage in simple AIH patients without ocular symptoms during oral prednisone treatment.

A Comparison of Observational Studies on Subfoveal Choroidal Thickness Measured with OCT according to the Level of Thyroid Eye Disease Activity-Systematic Review and Meta-Analysis

This study aims to systematise subfoveal choroidal thickness (SFCT) measured using optical coherence tomography (OCT) in patients with different severities of thyroid eye disease (TED) compared with healthy subjects. The PubMed, Web of Science and Scopus databases were searched for the following terms: ((Graves' ophthalmopathy) OR (thyroid eye disease) OR (Graves' orbitopathy) OR (thyroid-associated orbitopathy)) AND (choroidal thickness) AND ((optical coherence tomography) OR (OCT)). The pool of papers was narrowed down to articles published until 31 January 2023 (26, 26 and 96 papers, respectively). Twenty-five (25) articles were taken into consideration, which were original papers and included the choroidal thickness measurements among TED patients in their results. Finally, eight papers were included in the comparative analysis of the SFCT parameter in TED patients and a group of healthy controls, and seven papers in the comparative analysis of the same parameter between active and inactive TED patients. The mean value of the difference between the TED group and the healthy group was 38.79 μm, with a confidence interval (CI) from 0.09 to 77.49 μm (p = 0.0495). The mean difference between the active TED group and inactive TED group was 38.02 μm, with a CI from 8.62 to 67.42 μm (p = 0.0113). All the results were statistically significant.