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Lai KK, Ali Abdulla Aljufairi FM, Sebastian JU, Chin JK, Choy EK, Yiu AH, Lee AC, Ng CM, Yip WW, Young AL, Yuen HK, Tham CC, Pang CP, Chong KK. Euthyroid graves' ophthalmopathy in a Chinese population: A cross-sectional follow-up study. Eur J Ophthalmol 2024:11206721241229470. [PMID: 38444235 DOI: 10.1177/11206721241229470] [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: 03/07/2024]
Abstract
OBJECTIVES A subtype of patients with thyroid eye disease (TED) were found to be euthyroid without prior thyroid dysfunction or treatment, known as Euthyroid Graves' Ophthalmopathy (EGO). We report the prevalence, clinical and serological phenotypes of EGO in a Chinese population. METHODS A cross-sectional follow-up study. Ethnic Chinese TED patients were managed at the Thyroid Eye Clinic(TEC), Prince of Wales Hospital and TEC, the Chinese University of Hong Kong between September 2007 and July 2021. RESULTS A total of 66 (5%) patients among the 1266 ethnic Han Chinese TED cohort were diagnosed as EGO, and 6 (9%)of them become dysthyroid over an average of 74-month follow-up. EGO patients were associated with a longer duration between onset of the symptoms to our first consultation (P < 0.0001), a higher male-to-female ratio (P = 0.0045) and a higher age of disease onset (P = 0.0092). Family history of thyroid disease was more common in TED patients (P = 0.0216) than in EGO patients. EGO patients were more likely to present unilaterally (P < 0.0001), and they have a larger difference in MRD1 (P < 0.0001), and extraocular motility (P < 0.0001) between the 2 eyes when compared to the TED patients. Notably, the extraocular motility restriction of the worst eye was more affected in EGO patients (P = 0.0113). The percentages of patients who received IVMP, ORT and emergency or elective surgeries(decompression or squint operation) between EGO and TED were similar. CONCLUSIONS Understanding the important clinical phenotypes of EGO may help the clinician to make the correct diagnosis. Further study to compare EGO and TED is warranted.
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Affiliation(s)
- Kenneth Kh Lai
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
| | - Fatema Mohamed Ali Abdulla Aljufairi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
- Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Bahrain
| | - Jake Uy Sebastian
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
- Department of Ophthalmology, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - Joyce Ky Chin
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
| | - Eric Kh Choy
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
| | - Annika Hl Yiu
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
| | - Alan Ch Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Queen Mary Hospital, HKSAR, China
| | - C M Ng
- Department of Medicine, Queen Elizabeth Hospital, HKSAR, China
| | - Wilson Wk Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
| | - Hunter Kl Yuen
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
- Hong Kong Eye Hospital, HKSAR, China
| | - Clement Cy Tham
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
- Hong Kong Eye Hospital, HKSAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
| | - Kelvin Kl Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, HKSAR, China
- Hong Kong Eye Hospital, HKSAR, China
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Muralidhar A, Singh S, Das S, Mondal K, Kumar B, Agarwal M, Majumdar A. Choroidal thickness in thyroid eye disease and its correlation with disease activity. Indian J Ophthalmol 2024; 72:281-286. [PMID: 38146970 PMCID: PMC10941914 DOI: 10.4103/ijo.ijo_848_23] [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: 03/31/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 12/27/2023] Open
Abstract
CONTEXT This study adds to the existing body of literature on the role of optical coherence tomography (OCT) parameters in active thyroid eye disease (TED) among the Indian population. PURPOSE Comparison of choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) in active and inactive TED. SETTINGS AND DESIGN An observational, cross-sectional analytical study conducted at a tertiary eye care hospital in North India that included patients with active and inactive TED. METHODS Demographic details and clinical evaluation were performed for all TED patients. SFCT was determined with OCT by using the Cirrus linear measurement tool. CVI was calculated using Image J software. The SFCT and CVI measurements were compared between both groups. STATISTICAL ANALYSIS USED Comparison between active and inactive TED groups was done using Mann-Whitney U test for non-parametric data and Student t test for parametric data. Multivariate regression analysis was performed with SFCT and CVI as dependent variables. RESULTS Sixty-two eyes of 31 patients were included. Thirteen eyes had active TED, and 49 eyes had inactive TED. SFCT was significantly lower in eyes with higher clinical activity score (CAS) and older age. No significant difference was found in CVI between active and inactive TED eyes. CONCLUSION SFCT was lower in eyes with higher CAS and older age. Our findings differ from previous studies, which showed a positive correlation between SFCT and CAS. There was no significant difference in CVI between active and inactive TED eyes.
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Affiliation(s)
| | - Shalini Singh
- Vitreoretina Services, Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Sima Das
- Oculoplasty Services, Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Kheyali Mondal
- Oculoplasty Services, Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Brajesh Kumar
- Vitreoretina Services, Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Manisha Agarwal
- Vitreoretina Services, Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Statistician, Dr. Shroff Charity Eye Hospital, New Delhi, India
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Watanabe N, Kozaki A, Inoue K, Narimatsu H, Shinohara M, LoPresti MG. Prevalence, Incidence, and Clinical Characteristics of Thyroid Eye Disease in Japan. J Endocr Soc 2023; 8:bvad148. [PMID: 38075564 PMCID: PMC10701629 DOI: 10.1210/jendso/bvad148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Indexed: 01/06/2024] Open
Abstract
Background Although thyroid eye disease (TED) can impact social and psychological well-being, the epidemiological evidence of TED is lacking in Japan. Methods Nationwide claims databases provided by JMDC Inc. and Medical Data Vision Co., Ltd. and national population statistics are used. Three TED definitions ranging from a strict definition only including a TED diagnosis to a broad definition including a TED diagnosis and considering ocular symptoms are considered. The proportion of patients by severity and disease activity are estimated based on definitions that would allow identification of those patients within the claims data. Results The incidence rate per 100 000 person-years ranged from 7.3 to 11.1 for the strict and broad TED definitions, respectively. For fiscal year 2020 (April 2020 to March 2021) the prevalence rate ranged between 24.65 (strict TED) and 37.58 (broad TED) per 100 000 persons. These correspond to 25 383 and 38 697 patients for the strict and broad TED definitions, respectively. Regardless of the definition used, a predominance of female patients was observed, and the highest burden of the disease was seen in the age group of 35 to 59. Mild and inactive forms of TED were predominant (about 85% and 74%, respectively). Conclusion The incidence and prevalence of TED in Japan were 7.3 to 11.1 per 100 000 person-years and 24.65 to 37.58 per 100 000 persons, respectively. The robust results of this database study add valuable real-world evidence on the incidence and prevalence of TED in Japan.
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Affiliation(s)
- Natsuko Watanabe
- Department of Internal Medicine, Ito Hospital, Shibuya-ku, Tokyo, 150-8308 Japan
| | - Ai Kozaki
- Olympia Eye Hospital, Shibuya-ku, Tokyo, 150-0001 Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Hiroto Narimatsu
- Cancer Prevention & Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, 241-8515 Japan
| | - Masahiko Shinohara
- Real World Evidence Department, INTAGE Healthcare Inc., Chiyoda-ku, Tokyo, 101-0062 Japan
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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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Wong NTY, Yuen KFK, Aljufairi FMAA, Lai KKH, Hu Z, Chan KKW, Tham CCY, Pang CP, Chong KKL. Magnetic resonance imaging parameters on lacrimal gland in thyroid eye disease: a systematic review and meta-analysis. BMC Ophthalmol 2023; 23:347. [PMID: 37550660 PMCID: PMC10408192 DOI: 10.1186/s12886-023-03008-x] [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: 09/07/2022] [Accepted: 05/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Thyroid eye disease is an extrathyroidal manifestation of Graves' disease and is associated with dry eye disease. This is the first systematic review and meta-analysis to evaluate the role of magnetic resonance imaging lacrimal gland parameters in thyroid eye disease diagnosis, activity grading, and therapeutic responses prediction. METHODS Up to 23 August, 2022, 504 studies from PubMed and Cochrane Library were analyzed. After removing duplicates and imposing selection criteria, nine eligible studies were included. Risk of bias assessment was done. Meta-analyses were performed using random-effect model if heterogeneity was significant. Otherwise, fixed-effect model was used. Main outcome measures include seven structural magnetic resonance imaging parameters (lacrimal gland herniation, maximum axial area, maximum coronal area, maximum axial length, maximum coronal length, maximum axial width, maximum coronal width), and three functional magnetic resonance imaging parameters (diffusion tensor imaging-fractional anisotropy, diffusion tensor imaging-apparent diffusion coefficient or mean diffusivity, diffusion-weighted imaging-apparent diffusion coefficient). RESULTS Thyroid eye disease showed larger maximum axial area, maximum coronal area, maximum axial length, maximum axial width, maximum coronal width, diffusion tensor imaging-apparent diffusion coefficient/ mean diffusivity, and lower diffusion tensor imaging-fractional anisotropy than controls. Active thyroid eye disease showed larger lacrimal gland herniation, maximum coronal area, diffusion-weighted imaging-apparent diffusion coefficient than inactive. Lacrimal gland dimensional (maximum axial area, maximum coronal area, maximum axial length, maximum axial width, maximum coronal width) and functional parameters (diffusion tensor imaging-apparent diffusion coefficient, diffusion tensor imaging-apparent diffusion coefficient) could be used for diagnosing thyroid eye disease; lacrimal gland herniation, maximum coronal area, and diffusion-weighted imaging-apparent diffusion coefficient for differentiating active from inactive thyroid eye disease; diffusion tensor imaging parameters (diffusion tensor imaging-fractional anisotropy, diffusion tensor imaging-mean diffusivity) and lacrimal gland herniation for helping grading and therapeutic responses prediction respectively. CONCLUSIONS Magnetic resonance imaging lacrimal gland parameters can detect active thyroid eye disease and differentiate thyroid eye disease from controls. Maximum coronal area is the most effective indicator for thyroid eye disease diagnosis and activity grading. There are inconclusive results showing whether structural or functional lacrimal gland parameters have diagnostic superiority. Future studies are warranted to determine the use of magnetic resonance imaging lacrimal gland parameters in thyroid eye disease.
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Affiliation(s)
- Nicole Tsz Yan Wong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ka Fai Kevin Yuen
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Fatema Mohamed Ali Abdulla Aljufairi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Manama, Bahrain
| | - Kenneth Ka Hei Lai
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Zhichao Hu
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Karen Kar Wun Chan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Clement Chee Yung Tham
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Kelvin Kam Lung Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, Hong Kong, China.
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China.
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Lai KKH, Aljufairi FMAA, Li CL, Ngai AKY, Yeung CSK, Fong RHY, Yip WWK, Young AL, Pang CP, Chong KKL. Efficacy and Safety of 6-Weekly versus 12-Weekly Intravenous Methylprednisolone in Moderate-to-Severe Active Thyroid-Associated Ophthalmopathy. J Clin Med 2023; 12:jcm12093244. [PMID: 37176682 PMCID: PMC10179467 DOI: 10.3390/jcm12093244] [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: 03/05/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE To compare the efficacy and safety of 6-weekly and 12-weekly intravenous methylprednisolone (IVMP) regimens in moderate-to-severe, active thyroid-associated orbitopathy (TAO) patients. BASIC PROCEDURES Retrospective comparative study of patients who received IVMP between January 2011 and July 2021 at the Thyroid Eye Clinic, the Chinese University of Hong Kong. Outcome measures included the 7-item clinical activity score (CAS), exophthalmos, extraocular muscle motility (EOMy), marginal reflex distance (MRD), best corrected visual acuity (BCVA), intraocular pressure (IOP), the requirement of additional treatment, and complications. MAIN FINDINGS A total of 65 (63% (41/65) females) moderate-to-severe, active TAO patients aged 50 ± 13 (25-74) years received 6-weekly (n = 22) or 12-weekly (n = 43) IVMP. Sex, age, smoking status, and Graves' disease status were comparable in the two groups (all p > 0.05). CAS at week 6 (p = 0.0279), 12 (p = 0.00228), and 52 (p = 0.0228) were lower at each time for the 12-weekly group. Exophthalmos improved more at week 6 (p = 0.0453) and 12 (p = 0.0347) in the 12-weekly group. The improvement of diplopia, MRD1, MRD2, and EOMy were comparable between the two groups. More patients in the 6-weekly group (p = 0.00169) required additional treatments including IVMP+/-ORT. Patients in the 6-weekly group who did not require additional treatment had a lower presenting CAS (p = 0.0193) than those who required additional treatment. The total numbers of adverse events were comparable between the two groups.
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Affiliation(s)
- Kenneth K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Fatema Mohamed Ali Abdulla Aljufairi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Manama 323, Bahrain
| | - Chi Lai Li
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Amanda K Y Ngai
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Carly S K Yeung
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ryan H Y Fong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wilson W K Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong, China
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Sun R, Yang M, Lin C, Wu Y, Sun J, Zhou H. A clinical study of topical treatment for thyroid-associated ophthalmopathy with dry eye syndrome. BMC Ophthalmol 2023; 23:72. [PMID: 36803227 PMCID: PMC9940084 DOI: 10.1186/s12886-023-02805-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Clinically, thyroid-associated ophthalmopathy (TAO) patients were suffered from dry eye syndrome. Only a few relevant studies were about this topic. Our study was determined to provide high-level evidence for the treatment of TAO with dry eye syndrome. PURPOSE To compare the clinical effects of vitamin A palmitate eye gel and sodium hyaluronate eye drop forTAO patients with dry eye syndrome. METHODS The study was conducted in the Ophthalmology Department of the Ninth People's Hospital Affiliated with the Medical College of Shanghai Jiao Tong University from May to October 2020. A total of 80 mild or moderate-to-severe TAO patients with dry eye syndrome were randomly divided into two groups. The disease stages of all subjects were inactive. Patients in group A were treated with vitamin A palmitate eye gel three times/day for one month and sodium hyaluronate eye drop in group B. The index including break-up time (BUT) and Schirmer I test (ST), corneal fluorescence staining (FL), ocular surface disease index (OSDI), and adverse reactions were recorded by the same clinician at baseline and 1 month after treatment. The data were analyzed by SPSS 24.0. RESULTS Finally, 65 subjects completed the treatment. The average age of the patients in Group A was 38.1 ± 11.4 years, and that in Group B was 37.26 ± 10.67 years. 82% of the subjects in group A were female and 74% in group B. There was no significant difference between the two groups at baseline, including the value of ST, BUT, OSDI, and FL grade. After the treatment, the effective rate was 91.2% in group A, of which the value of BUT and FL grade was significantly improved (P < 0.001). The effective rate in group B was 67.7%, of which the value of OSDI score and FL grade was significantly improved (P = 0.002). In addition, the BUT value of group A was significantly longer than that of group B (P = 0.009). CONCLUSION InTAO patients with dry eye syndrome, vitamin A palmitate gel and sodium hyaluronate eye drop improved the dry eye and promoted corneal epithelial repair. Vitamin A palmitate gel improves the stability of tear film, while sodium hyaluronate eye drop improves patients' subjective discomfort.
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Affiliation(s)
- Rou Sun
- grid.412523.30000 0004 0386 9086Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
| | - Muyue Yang
- grid.412523.30000 0004 0386 9086Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
| | - Chenyi Lin
- grid.412523.30000 0004 0386 9086Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
| | - Yu Wu
- grid.412523.30000 0004 0386 9086Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
| | - Jing Sun
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Eshraghi B, Pourazizi M, Abbasi M, Mohammadbeigy I. Hypo vs. hyperthyroid eye disease: is there any difference? BMC Ophthalmol 2023; 23:58. [PMID: 36765316 PMCID: PMC9912537 DOI: 10.1186/s12886-023-02806-7] [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: 01/14/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Thyroid-eye disease (TED) is the most common extra-thyroidal presentation of graves' disease. We performed this study to compare clinical characteristics of TED in hypothyroid vs. hyperthyroid patients. METHODS This was a retrospective analytical cross-sectional study in which we compared demographics, severity (EUGOGO classification) and activity (clinical activity score) of TED, thyroid disease duration, TED duration and clinical signs between hypothyroid eye disease (Ho-TED) and hyperthyroid eye disease (Hr-TED). To minimize the effect of selection bias and potential confounders, 1:1 propensity score matching (PSM) was also performed. RESULTS Three hundred and seventy-four patients (341 Hr-TED and 33 Ho-TED) with a female to male ratio of 1.4:1 were identified in our study. Female to male ratio was 1.3:1 in hyperthyroid and 4.5:1 in hypothyroid group (P = 0.005). The duration of thyroid disease was longer in Ho-TED (P = 0.002) while the duration of eye disease was not significantly different between the Hr-TED (mean = 24.33 ± 41.69, median = 8) and Ho-TED (mean = 19.06 ± 33.60, median = 12) (P = 0.923). Most of the patients in hypothyroid group developed eye involvement after thyroid disease (80.0% in hypo vs. 48.1% in hyper, P = 0.003). Severity (P = 0.13) and activity (P = 0.11) was not different between Hr-TED and Ho-TED patients. After PSM analysis, no clinical characteristics were significantly different between the two groups (P > 0.05). CONCLUSION The results of our study showed several differences between the Hr/Ho TED patients including sex, duration of thyroid disease and pattern of eye involvement. After matching the two groups with statistical methods, no clinical characteristics were different between Hr-TED and Ho-TED patients.
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Affiliation(s)
- Bahram Eshraghi
- grid.411036.10000 0001 1498 685XIsfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- grid.411036.10000 0001 1498 685XIsfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Abbasi
- grid.411036.10000 0001 1498 685XIsfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Mohammadbeigy
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Goel R, Shah S, Sundar G, Arora R, Gupta S, Khullar T. Orbital and ocular perfusion in thyroid eye disease. Surv Ophthalmol 2023; 68:481-506. [PMID: 36681278 DOI: 10.1016/j.survophthal.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/20/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Thyroid eye disease (TED) is characterized by enlargement of extraocular muscles, an increase in retrobulbar fat, orbital fibrosis, and fluctuations in plasma thyroid hormone levels in most patients, often associated with raised autoantibody titers. The occurrence of orbital space conflict compromises the orbital perfusion, unchecked progression of which results in irreversible loss of visual acuity and visual fields. The quantitative assessment of orbital perfusion can be done by measurement of blood flow velocities in the superior ophthalmic vein (SOV), ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery by color Doppler imaging. The retinal and choroidal microvasculature is studied by optical coherence tomography and optical coherence tomography angiography. The orbital and ocular perfusion fluctuates during the course of TED. Orbital congestion is reflected by the reduction or reversal of SOV flow and an increase in subfoveal choroidal thickness. The active phase is characterized by high blood flow velocities of the OA and CRA. The onset of dysthyroid optic neuropathy is associated with reduced arterial perfusion and reduction in parafoveal and peripapillary vascular density. Orbital decompression improves the SOV flow and decreases the resistivity index of CRA. Sequential evaluation of orbital hemodynamic changes can thus supplement the clinical scoring systems for monitoring and planning intervention in TED.
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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
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, Kent Ridge, Singapore
| | - Ritu Arora
- 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
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Subramaniam DL, Yadalla D, Rajagopalan J. Are Severe Forms of Thyroid Eye Disease Common in the Indian Population? Clinical Characteristics of 136 Patients from a Tertiary Eye Care Centre. Indian J Endocrinol Metab 2023; 27:56-61. [PMID: 37215269 PMCID: PMC10198202 DOI: 10.4103/ijem.ijem_280_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/19/2021] [Indexed: 03/05/2023] Open
Abstract
Context Considerable evidence of gender, ethnicity, thyroid dysfunction, and environmental factors including smoking influencing the development and progression of thyroid eye disease (TED). Settings and Design Cross-sectional study of the clinical characteristics of 136 patients with TED who presented to the Orbit and Oculoplasty services at a tertiary eye care center in south India between October 2018 and June 2020. Results Among the 136 patients (M: 61, F: 75), the mean age was 47.04 (SD ± 13.24) years. Hyperthyroid disease was present in 53%, hypothyroid disease in 40%, and 7.3% were euthyroid. Active disease was noted in 25% and inactive disease in 75% of patients. Active disease was present in 25% of hyperthyroid, 18.5% of hypothyroid, and 15% of euthyroid patients. Active TED showed statistically significant association toward development of greater severity of proptosis (P = 0.001), optic neuropathy (P = 0.004), and extraocular movement restriction (P < 0.001) as compared to inactive disease. Mild, moderate to severe, and sight-threatening TED was noted in 34.6%, 59.6%, and 6% of patients, respectively. Nine eyes had dysthyroid optic neuropathy, of which eight had either mild or no proptosis while one had moderate to severe proptosis. Conclusion Prevalence of active as well as severe thyroid eye disease is common in our population. Recommendation for ophthalmological examination of patients even with milder disease especially when associated with decreased vision and signs of inflammation. Active disease is less common in euthyroid patients, thus necessitating maintaining the euthyroid status toward reducing disease activity and progression.
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Affiliation(s)
- Dhakshini L. Subramaniam
- Department of Orbit and Oculoplasty Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Dayakar Yadalla
- Department of Orbit and Oculoplasty Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Jayagayathri Rajagopalan
- Department of Orbit and Oculoplasty Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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12
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Young SM, Kim JH, Kim YD, Karnsiritanont V, Lang SS, Woo KI. Hyaluronic acid gel injection for dysthyroid upper eyelid retraction in Asian patients. Orbit 2022:1-8. [PMID: 36082627 DOI: 10.1080/01676830.2022.2117385] [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: 10/14/2022]
Abstract
PURPOSE To evaluate the role of hyaluronic acid (HA) filler injection in the management of upper eyelid retraction (UER) in thyroid eye disease (TED). METHODS Retrospective interventional series of all patients with TED who had undergone HA injection, from February 2011 to April 2013 by a single surgeon (Y-DK) in a tertiary medical institution. Outcome measures: Mean margin reflex distance 1 (MRD1) pre- and post-filler. RESULTS There was a total of 13 patients and 17 eyes included in the study. The injection dosage for 15 eyes was 0.5 ml, one patient had 0.35cc on the right eye and 0.65cc on the left eye. Mean MRD1 at presentation was 6.21 mm. There was a mean decrease in MRD1 of 2.01 mm (p < .001) at 1 month post filler, 2.06 mm (p < .001) at 6 months post filler and 2.61 mm (p < .001) at 1 year post filler. There was no correlation between pre-filler MRD1 and change in MRD1 at various time points post-filler, nor any correlation between pre-filler upper scleral show (USS) and change in USS post-filler. There was also no correlation found between clinical activity score (CAS) and change in MRD1, as well as duration of thyroid eye disease (TED) and change in MRD1. Complications included mild upper lid lumpiness on downgaze (n = 4, 23.5%) which improved but persisted with time. There were no untoward intravascular or vision-threatening complications. CONCLUSION Transconjunctival HA injection is an effective treatment option for TED-related UER in both active and inactive TED patients in an East Asian population, with a potentially long-lasting effect.
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Affiliation(s)
| | - Jeong Hee Kim
- Department of Ophthalmology, Saevit Eye Hospital, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Oculoplastics, Nune Eye Hospital, Seoul, Korea
| | | | | | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Centre, Seoul, Korea
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Dave TV, Jonnadula GB, Lanka P, Natarajan R, Dave VP. Choroidal vascularity index in thyroid eye disease: comparison with controls and application in diagnosing non-inflammatory active disease. Orbit 2022; 41:89-96. [PMID: 34979862 DOI: 10.1080/01676830.2021.2014893] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the differences in choroidal vascularity index (CVI) in thyroid eye disease (TED) and normals and its discriminatory value for differentiating various stages of TED. METHODS Prospective, cross-sectional, non-interventional imaging study. Ninety-four eyes of 54 patients were included and divided into 5 groups - normal controls (C), inactive TED (I), active TED (A), non-inflammatory active TED (NIA) and systemic hyperthyroid disorder but no TED (SYS). Choroidal images were acquired using the swept-source optical coherence tomography and the choroid was binarized to calculate the CVI. RESULTS Ninety-four eyes were included. Mean age was 44.52 ± 10.02 years (median 46 years, range 19-65 years). Mean IOP was 16.1 ± 3.37 mm Hg (median 16 mm Hg, range 16-24 mm Hg). Mean Spherical equivalent (SE) was -0.08 ± 1.86 diopters (median 0, range -2.5 to +2.25). Intra-rater agreement was 0.84 (p < 0.001). Inter-rater agreement was noted to be 0.85 (p < 0.001) for consistency and 0.77 (p < 0.001) for absolute agreement. CVI in the A group was 70.11 ± 3.38% and in the NIA group was 69.32 ± 3.5%. Both were comparable to each other and significantly higher than the C, I and SYS groups (p < 0.001). Multiple regression showed that the Clinical Activity Score (CAS) had a positive effect and spheroequivalent had a negative effect on the CVI. At CVI of 66.83%, active TED can be diagnosed with sensitivity of 91.67% and specificity of 82.14% . CONCLUSIONS CVI is significantly higher in active TED and NIA TED compared to other groups. It has a good value in differentiating the non-inflammatory active TED eyes from the inactive eyes.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Ganesh Babu Jonnadula
- Image Reading Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Prashanthi Lanka
- Image Reading Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Ramya Natarajan
- Ophthalmic Biophysics, Kallam Anji Reddy Campus, Lv Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, Lv Prasad Eye Institute, Hyderabad, India
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14
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Hussein A, Loh U, Qamarruddin F. The study of relationship between ocular biometry and exophthalmometry in adult Malay population of Kelantan, Malaysia. Taiwan J Ophthalmol 2022; 12:44-52. [PMID: 35399980 PMCID: PMC8988974 DOI: 10.4103/tjo.tjo_88_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/15/2020] [Indexed: 11/04/2022] Open
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15
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Eshraghi B, Nikdel M, Abbasi M. Epidemiological Status of Thyroid Eye Disease in Central Iran. J Curr Ophthalmol 2022; 34:106-111. [PMID: 35620368 PMCID: PMC9128421 DOI: 10.4103/joco.joco_223_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To focus on clinical manifestations and epidemiology of thyroid eye disease (TED) in Central Iran's population. Methods In this retrospective case study, we analyzed all patients with TED who were referred to our oculoplastic clinic from 2015 to 2019. The patients' epidemiological characteristics and clinical presentation were compared between different thyroid disease groups and genders. Results Overall, 383 patients (155 male; 40.5% and 228 female; 59.5%) were included. The mean age was 39.55 years (standard deviation ± 13.45, range 10-72). Most patients (89%) were hyperthyroid with the highest duration of ocular involvement among all categories (25.6 months). The most common signs on ophthalmic examinations were proptosis (80.4%), followed by eyelid retraction (72.3.0%). TED was classified as mild in 24.5%, moderate to severe in 67.6%, and sight-threatening in 7.9%. Thirty patients (7.8%) had active TED. Conclusions This series with a relatively more significant number of TED cases in Central Iran found similar epidemiological and clinical characteristics of TED compared to other studies from Iran. Most of our patients were hyperthyroid, with more females compared to males. Proptosis and eyelid retraction were the most common manifestations. Most TED patients were classified as moderate to severe.
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Affiliation(s)
- Bahram Eshraghi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Maryam Abbasi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Dave TV, Natarajan R, Reddy RU, Kapoor AG, Dave VP. Choroidal Thickness in Thyroid Eye Disease: Comparison With Controls and Application in Diagnosing Non-Inflammatory Active Disease. Cureus 2021; 13:e19779. [PMID: 34956776 PMCID: PMC8693536 DOI: 10.7759/cureus.19779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Choroidal thickness is known to vary in various systemic diseases. In the current study, we aim to report the differences in choroidal thickness in thyroid eye disease (TED) and normals and its discriminatory value for differentiating various stages of TED. Methods Prospective, cross-sectional, non-interventional imaging study. In an institutional practice, 102 eyes of 51 patients were included and divided into five groups: normal controls (C), inactive TED (I), active TED (A), non-inflammatory active TED (NIA) and systemic thyroid disorder but no TED (SYS). Choroidal images were acquired using the swept-source optical coherence tomography (Topcon DRI OCT Triton) with automatic layer segmentation which provided an automatic measurement of the subfoveal choroidal thickness and the mean in nine subfields based on the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. One-way analysis of variance (ANOVA), Youden index and area under the receiver operating characteristic curves (AUROC) were reported. Results Central choroidal thickness in the A group was 279±37.52 microns and in the NIA group was 302.5±59.22 microns. Both were comparable to each other and significantly higher than the C, I and SYS groups (p<0.001). All ETDRS sub-fields showed significant AUROC to distinguish NIA from I. Most significant Youden index was for the inner nasal and central ETDRS subfields (0.55 and 0.61 respectively). Inner nasal sub-field showed 100% specificity while the central sub-field, showed 86.5% for predicting NIA. At a choroidal thickness of >266 microns, the central sub-field had the strongest discriminatory potential to predict NIA. Conclusion Choroidal thickness is greater in active and non-inflammatory active TED. The inner nasal and central ETDRS sub-fields have value in differentiating the non-inflammatory active TED eyes from the inactive eyes.
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Affiliation(s)
- Tarjani V Dave
- Oculoplastic Surgery, LV Prasad Eye Institute, Hyderabad, IND
| | - Ramya Natarajan
- Ophthalmic Biophysics, LV Prasad Eye Institute, Hyderabad, IND
| | - Rakshi Ugandhar Reddy
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, IND
| | - Anasua G Kapoor
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, Vijayawada, IND
| | - Vivek P Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, IND
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17
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Chen KW, Phelps PO. Acquired Epiblepharon Alleviated With Teprotumumab Treatment in Active Thyroid Eye Disease Patient. Ophthalmic Plast Reconstr Surg 2021; 37:e195-e196. [PMID: 34269764 DOI: 10.1097/iop.0000000000002002] [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: 11/26/2022]
Abstract
A 46-year-old Asian female patient with thyroid eye disease reported ocular irritation, eyelid swelling, diplopia, and pain with eye movement. The patient was diagnosed with active thyroid eye disease and secondary thyroid eye disease-acquired epiblepharon, which was causing bilateral punctate epithelial erosion. Treatment was started with newly U.S. Food and Drug Administration approved teprotumumab, an insulin-like growth factor-1 receptor inhibitor. Four infusion treatments later, the patient's epiblepharon was alleviated with minimal side effects. In this report, the authors present a case of thyroid eye disease-acquired epiblepharon resolving with teprotumumab treatment.
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Affiliation(s)
- Kevin W Chen
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Paul O Phelps
- Division of Ophthalmology, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, U.S.A
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Liew H, Watt T, Nan L, Tan AWK, Chan YH, Chew DEK, Dalan R. Psychometric properties of the thyroid-specific quality of life questionnaire ThyPRO in Singaporean patients with Graves' disease. J Patient Rep Outcomes 2021; 5:54. [PMID: 34236563 PMCID: PMC8266927 DOI: 10.1186/s41687-021-00309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Graves’ disease is the most common cause of hyperthyroidism. It results in accelerated tissue metabolism with multi-organ involvement ranging from cardiovascular to neuropsychological function. This results in a negative impact on the quality of life (QOL) of the individual patient. We aim to evaluate the psychometric properties of ThyPRO, a Thyroid-related Patient Reported Outcome questionnaire, and validate its use in our multi-ethnic Asian patients with Graves’ hyperthyroidism. Methods Forty-seven consecutive Graves’ hyperthyroidism patients answered the ThyPRO questionnaire at baseline and at 4 months after treatment initiation. Data were recorded for thyroid related symptoms and signs, thyroid function tests and thyroid volume. We analyzed the internal consistency using Cronbach’s alpha, construct validity by evaluating relationship between clinical variables and ThyPRO scales, ceiling and floor effects, and responsiveness of ThyPRO to treatment based on Cohen’s effect size. Results Correlations between individual scale scores and free thyroxine concentrations were moderate and statistically significant: 0.21–0.64 (p < 0.05). There was high internal consistency between the items in this instrument, Cronbach’s alpha > 0.7 for all scales. ThyPRO was responsive to the changes in QOL after treatment (Effect Size: 0.20–0.77) in 9 of the 14 scales including the hyperthyroid symptoms and psychosocial scales (Tiredness, Cognitive complaints, Anxiety, Emotional susceptibility, Impact on Social, Daily and Sex life). Conclusion This study provides evidence that ThyPRO has satisfactory measurement properties in hyperthyroid Graves’ disease patients in Singapore population with the potential to complement clinical care. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00309-x.
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Affiliation(s)
- Huiling Liew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Luo Nan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin W K Tan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Ek Kwang Chew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rinkoo Dalan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Gupta R, Thomas R, Almukhtar F, Kiran A. Visual morbidity in thyroid eye disease in Asian Indian patients. Indian J Ophthalmol 2021; 68:1622-1627. [PMID: 32709792 PMCID: PMC7640861 DOI: 10.4103/ijo.ijo_2284_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: To describe visual morbidity in thyroid orbitopathy in Asian Indians and the factors influencing its onset. Methods: A retrospective chart review was performed for patients with thyroid related orbitopathy seen between May 2014 and April 2019. Three hundred and one patients were included in the study. Relevant history, clinical findings, investigations, and treatment were documented. Results: Nineteen percent of patients had at least 1 visual morbidity feature such as compressive optic neuropathy, exposure keratopathy or diplopia, requiring intravenous glucocorticoid. Male gender, older age, and diabetes were the significant risk factors for high visual morbidity (all P < 0.05). Systemic thyroid status, degree of proptosis, and duration of disease were not significant. Average dose of intravenous glucocorticoid needed was 3.8 g; 24 (7.9%) patients required orbital decompression, and 13 (4.3%) needed eyelid surgery. At the last follow-up, 97% of patients had vision 6/12 or better in both eyes. Conclusion: There is significant visual morbidity found in Indian patients with TED, even with moderate proptosis and systemic control of thyroid status. This is the first set of data on the subject.
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Affiliation(s)
- Roshmi Gupta
- Orbit and Oculoplasty Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rwituja Thomas
- Orbit and Oculoplasty Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Fatema Almukhtar
- Orbit and Oculoplasty Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Anjali Kiran
- Orbit and Oculoplasty Services, Narayana Nethralaya, Bengaluru, Karnataka, India
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Muralidhar A, Das S, Tiple S. Clinical profile of thyroid eye disease and factors predictive of disease severity. Indian J Ophthalmol 2021; 68:1629-1634. [PMID: 32709794 PMCID: PMC7640822 DOI: 10.4103/ijo.ijo_104_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To describe the clinical features of thyroid eye disease (TED) in patients presenting at a tertiary eye care centre in North India and to identify factors predictive of severe disease. Methods: This observational cross-sectional study involved clinical evaluation of all patients with TED who presented at the oculoplastic clinic based on the ITEDS VISA proforma. Risk factors for the severe disease were assessed using univariate and multivariate logistic regression. Results: A total of 106 patients (50 males, 56 females; mean age 41.30 ± 14.76 years) were identified during the study period, 46.23% hyperthyroid, 33.96% hypothyroid and 19.81% euthyroid. The proportion of the patients with hypothyroid was higher as compared with prior studies and most patients with hypothyroid had the mild disease (63.89%). Orbitopathy symptoms were the presenting feature leading to the diagnosis of systemic thyroid abnormality in 25% of the patients with hypothyroid and 59.18% of the patients with hyperthyroid, respectively (P < 0.05). Eyelid and orbitopathy signs were more common in the patients with hyperthyroid (51.2% and 87.7%) as compared with hypothyroid where the commonest presenting symptoms were related to dry eye (50.1%). Active disease was seen in 22.6% of the patients. Mild, moderate to severe and sight-threatening disease was seen in 54.7%, 37.7% and 7.5%, respectively. On multivariate analyses, hyperthyroid status and activity was associated with severe disease. Smoking was not associated with activity or severity. Conclusion: There is no significant difference in the gender profile of the patients with TED in this cohort. The patients with hypothyroid have a milder disease compared to the patients with hyperthyroid, and dry eye symptoms are the commonest presenting symptoms in hypothyroid subjects. Hyperthyroidism and activity were associated with severe and sight-threatening disease.
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Affiliation(s)
- Alankrita Muralidhar
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Sima Das
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Sweety Tiple
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
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21
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Loiudice P, Pellegrini M, Marinò M, Mazzi B, Ionni I, Covello G, Figus M, Nardi M, Casini G. Choroidal vascularity index in thyroid-associated ophthalmopathy: a cross-sectional study. EYE AND VISION 2021; 8:18. [PMID: 33926559 PMCID: PMC8086083 DOI: 10.1186/s40662-021-00242-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/13/2021] [Indexed: 11/22/2022]
Abstract
Background Hemodynamic changes have been observed in patients with Graves’ disease. The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index (CVI) in patients with thyroid-associated ophthalmopathy (TAO). Methods In this cross-sectional observational study, 40 patients affected by TAO were recruited. Forty healthy individuals, matched for age and sex, served as controls. Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants. Images were binarized using the ImageJ software and luminal area (LA) and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. The relation between CVI or subfoveal choroidal thickness (SFCT) and clinical activity score, exophthalmometric value, diplopia status, gender, and age was evaluated. Results CVI was significantly higher in patients with TAO (P = 0.004). No significant difference was observed in SFCT (P = 0.200) and TCA (P = 0.153) comparing TAO patients and healthy controls. LA was significantly higher in TAO group (P = 0.045). On multiple regression analysis, CVI was associated with TCA (P = 0.043). No association was found between SFCT or CVI and TCA, clinical activity score, exophthalmometric value, Inami value, diplopia status, gender or age (P > 0.05). Conclusions This is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.
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Affiliation(s)
- Pasquale Loiudice
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy.
| | - Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Michele Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University Hospital of Pisa, Pisa, Italy
| | - Barbara Mazzi
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University Hospital of Pisa, Pisa, Italy
| | - Ilaria Ionni
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Covello
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Michele Figus
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Marco Nardi
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Giamberto Casini
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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Abstract
PURPOSE The aim of this systematic review is to provide 1) an understanding of the components of quality of life (QOL) questionnaires and 2) an up-to-date insight of the types of QOL questionnaires available, strengths and limitations based on current literature. METHODS A literature search was conducted from 18 to 21 of February 2019 using 6 major databases: Cochrane Library, Ovid Medline, PubMed, Scopus, Taylor and Francis, and Web of Science. All papers were skimmed by title and abstract to determine whether the paper fulfilled the screening criteria. In cases of uncertainty, the paper was read in totality to justify its inclusion. After that, duplicates were eliminated and the remainder was subjected to a second set of inclusion and exclusion criteria before finalizing the list of included studies. RESULTS An initial search returned with 402 studies, which were subsequently filtered using prespecified criteria to 27 studies to collate information regarding questionnaires assessing QOL of thyroid eye disease patients. CONCLUSIONS The QOL of thyroid eye disease patients is best assessed using disease-specific questionnaires. Among the different types of questionnaires, the Graves Ophthalmopathy Quality of Life (GO-QOL) questionnaire is preferred due to its' ability to explore QOL in-depth and proven efficacy in many countries after cultural adaptation at the expense of time. Single-item questionnaires like the Thyroid Eye Disease Quality of Life (TED-QOL) are more suitable as screening tools in busy metropolitan settings while semi-structured interviews are important in developing new ways of assessing the QOL of thyroid eye disease patients.
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Mbarek S, Abid F, Ammari W, Alaya W, Mahmoud A, Messaoud R. Graves' Orbitopathy: Report of 82 cases. LA TUNISIE MEDICALE 2021; 99:243-251. [PMID: 33899194 PMCID: PMC8724701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Graves' disease (GD) is a common autoimmune disorder. Graves'orbitopathy (GO) is its most common extrathyroidal manifestation. It is rare but may reveal the disease. AIM To describe the demographic, clinical and therapeutic features of GO. METHODS We carried out a retrospective and descriptive analysis of 82 patients with GO. This study was conducted in Ophthalmology and Endocrinology departments of Taher Sfar University Hospital in Mahdia, between January 2010 and December 2017. GD patients diagnosed with GO were included. RESULTS The mean age was 36.17 years ± 12.81. Patients aged 19-40 years had the highest rate of GO. The male-to-female ratio was 0.49. Family history of autoimmune thyroid disease was present in 15% and associated autoimmune disease in 4% of cases. Smoking was seen in 71% of patients. The onset of GO was simultaneous with onset of GD in 45%, before in 21% and after the onset of GD in 34% of cases. GO was bilateral in 76% of patients. The most common ocular symptoms were prominent eyes (55% of patients), ocular pain (11%) and diplopia (41%). Proptosis and upper eyelid retraction were the most common clinical signs (93% and 90% respectively). Dysthyroid optic neuropathy was present in one eye, keratitis in one eye and glaucoma in five eyes. Severe disease was noted in 11% and active disease was present in 7% of patients. CT-scan and magnetic resonance imaging scan (MRI) were performed in 48% and 42% of cases respectively. Proptosis was the most common radiological sign. Thyroid dysfunction was managed with anti-thyroid medication only (59%), thyroxine replacement (37%), radioactive iodine (35%) and thyroidectomy (6%). 20% of patients received corticosteroids. One patient required immunosuppressive therapy. CONCLUSION GO is a complex disease, which is associated with impaired quality of life and can potentially result in sight-threatening complications. Appropriate diagnosis, convenient therapy and a regular follow-up are necessary to improve results and avoid the aesthetic and functional sequelae.
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Affiliation(s)
- Sameh Mbarek
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Fatma Abid
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Wafa Ammari
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Wafa Alaya
- 2-Service d'endocrinologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Anis Mahmoud
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Riadh Messaoud
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
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Seo ST, Sundar G, Young SM. Postoperative Quality of Life in Oculoplastic Patients. Ophthalmic Plast Reconstr Surg 2021; 37:12-17. [PMID: 32358236 DOI: 10.1097/iop.0000000000001681] [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: 11/26/2022]
Abstract
PURPOSE To conduct a literature review on postoperative quality of life in oculoplastic patients. METHODS The authors conducted a database search to evaluate the evidence available for the change in quality of life after oculoplastic surgery. RESULTS There was a wide disparity of evidence available for different oculoplastic conditions. Certain conditions, such as nasolacrimal duct obstruction, were well-researched while other conditions, such as epiblepharon, had little to no research supporting improvement in quality of life after surgery. The scales used to measure quality of life displayed heterogeneity. CONCLUSION There is a lack of published evidence concerning postoperative quality of life in patients with certain oculoplastic conditions such as brow ptosis, entropion, ectropion, epiblepharon, and orbital wall fracture. There is a need to standardize the quality of life data collection tools and scoring systems to allow better comparison and scrutiny of the current literature.
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Affiliation(s)
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, Singapore
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25
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Du B, Wang Y, Yang M, He W. Clinical features and clinical course of thyroid-associated ophthalmopathy: a case series of 3620 Chinese cases. Eye (Lond) 2020; 35:2294-2301. [PMID: 33139874 DOI: 10.1038/s41433-020-01246-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/13/2020] [Accepted: 10/19/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To determine the clinical features and course of thyroid-associated ophthalmopathy (TAO) in a large sample of Chinese patients. DESIGN AND METHODS We retrospectively identified a cohort of consecutive patients diagnosed with TAO at the West China Hospital from October 1, 2009 to October 1, 2019. We analysed clinical data from 3620 patients, including demographic data, clinical manifestations, ophthalmology examinations, and prognosis. RESULTS TAO most frequently occurred with hyperthyroidism, with most patients developing TAO after thyroid disease (TD). The TAO phenotype was asymmetric in 375 (50.7%) euthyroid patients, 25 (27.8%) hypothyroid patients, and 314 (12.1%) hyperthyroid patients (p < 0.0001). The most frequent symptom was lid lag and the most commonly involved extraocular muscle was the inferior rectus. Severity assessment (NOSPECS score) and clinical activity assessment (Clinical Activity Scores, CAS) differed significantly between male and female patients (P < 0.000). The majority (88.8%) of patients had clinically inactive TAO, and only 3.2% of cases were sight-threatening. Regarding the clinical process, 75.5% of patients had an active phase time less than 12 months and 2.1% showed complete remission. CONCLUSIONS TAO most commonly develops in females and is closely related to hyperthyroidism. Euthyroid TAO often has an asymmetric clinical phenotype. CAS combined with magnetic resonance imaging can improve the detection of TAO. NOSPECS scores should be slightly refined regarding the criteria for corneal involvement. Clinical management of TAO should be individualized according to CAS or NOSPECS assessments and a multidisciplinary approach is paramount. A minority of patients showed complete remission.
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Affiliation(s)
- Baixue Du
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, Sichuan Province, 610041, China
| | - Yujiao Wang
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, Sichuan Province, 610041, China
| | - Mei Yang
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, Sichuan Province, 610041, China
| | - Weimin He
- Department of Ophthalmology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, Sichuan Province, 610041, China.
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Sim B, Chng CL, Audrey C, Seah LL. A retrospective study of pediatric thyroid eye disease: the Asian experience. Orbit 2020; 41:69-78. [PMID: 33059514 DOI: 10.1080/01676830.2020.1831550] [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: 10/23/2022]
Abstract
AIM To study the clinical presentation, disease characteristics, and management approach for children with thyroid eye disease (TED) over a 10 year period in a multidisciplinary Paediatric Thyroid Eye Disease Clinic at a tertiary care referral center. METHODS Retrospective case series of patients with TED at Kandang Kerbau Women's and Children's Hospital (KKWCH) Singapore between August 2006 to June 2015. The diagnosis of TED was clinical based on the Bartley criteria. Ophthalmic examination findings, systemic thyroid function and ophthalmological intervention were recorded. RESULTS Nineteen subjects with pediatric TED were studied. The median age at diagnosis was 12.5 years (range 6-17). The onset of TED was at the same time as their thyroid disease in half of these patients (52.6%) of which all were hyperthyroid except one. The most common signs at TED diagnosis were proptosis (84.2%), lid retraction (63.2%), acquired epiblepharon (63.2%). All patients were inactive and none had evidence of compressive optic neuropathy. TED remained stable in all patients except for one who developed worsening proptosis with exposure keratopathy. No patients were prescribed steroids (oral or intravenous) or had orbital decompression surgery. The most debilitating morbidity was acquired epiblepharon of which out of 12 patients, one had everting sutures and three were offered surgical correction. CONCLUSIONS Paediatric TED subjects exhibit milder clinical manifestations compared to adults. Acquired epiblepharon causes most significant visual morbidity by compromising the corneal surface. Being cognizant of the subtleties of pediatric TED will permit the discerning clinician to effectively manage such cases accordingly.
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Affiliation(s)
- Bryan Sim
- Singapore National Eye Centre, Singapore, Singapore
| | - Chiaw Ling Chng
- Singapore National Eye Centre, Singapore, Singapore.,Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Chia Audrey
- Singapore National Eye Centre, Singapore, Singapore.,Kandang Kerbau Women's and Children's Hospital (KKWCH), Division of Ophthalmology, Singapore, Singapore
| | - Lay Leng Seah
- Singapore National Eye Centre, Singapore, Singapore.,Kandang Kerbau Women's and Children's Hospital (KKWCH), Division of Ophthalmology, Singapore, Singapore
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27
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Demographic and clinical profile of 1000 patients with thyroid eye disease presenting to a Tertiary Eye Care Institute in India. Int Ophthalmol 2020; 41:231-236. [PMID: 32844239 DOI: 10.1007/s10792-020-01571-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the demographic and clinical profile of thyroid eye disease (TED) presenting to a Tertiary Eye Care Institute in India. METHODS All patients who were diagnosed to have TED between the year 2007 and 2017 at the Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, were included in this retrospective observational study. The demographic details of parameters such as age, gender and laterality, presenting signs and symptoms, clinical activity at presentation, and systemic thyroid status were assessed. RESULTS A total of 1000 consecutive patients of TED were evaluated in the 10-year period. Average age at presentation was 44.9 years (range 8-89). Of the 1000, 529 (53%) were males, and 358 (36%) had unilateral TED. At presentation, the TED was active (time since onset ≤ 12 months) in 476 (48%) cases and 71 (7%) had dysthyroid optic neuropathy. Of the 913 patients where systemic thyroid status was available at the time of presentation, 342 (37%) were euthyroid at presentation. Of the patients who were active at presentation (n = 476), 349 (70.3%) were 'Silent presenters' (Active as per timeline, but CAS ≤ 3). A prominent eye was the most common presenting symptom in 563 (64%) patients. Presenting signs in order of frequency were proptosis in 582 (58%), lower lid retraction (49%), upper lid retraction (48%), strabismus (6%), ptosis (5.5%), and corneal ulcer (1.3%). CONCLUSIONS TED in India presents to the tertiary eye center with slight male preponderance. One-third (37%) are euthyroid and half (48%) are active at presentation. One-third (35%) are silent presenters, with minimal clinical activity during the active phase of TED.
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Affiliation(s)
- Ashok Kumar Grover
- Department of Ophthalmology, Sir Ganga Ram Hospital and Vision Eye Centres, New Delhi, India
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29
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Mishra S, Maurya VK, Kumar S, Ankita, Kaur A, Saxena SK. Clinical Management and Therapeutic Strategies for the Thyroid-Associated Ophthalmopathy: Current and Future Perspectives. Curr Eye Res 2020; 45:1325-1341. [DOI: 10.1080/02713683.2020.1776331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Shailja Mishra
- Department of Ophthalmology, King George’s Medical University (KGMU), Lucknow, India
| | - Vimal K Maurya
- Department of Centre of Advanced Research (CFAR), King George’s Medical University (KGMU), Lucknow, India
| | - Swatantra Kumar
- Department of Centre of Advanced Research (CFAR), King George’s Medical University (KGMU), Lucknow, India
| | - Ankita
- Department of Ophthalmology, King George’s Medical University (KGMU), Lucknow, India
| | - Apjit Kaur
- Department of Ophthalmology, King George’s Medical University (KGMU), Lucknow, India
| | - Shailendra K Saxena
- Department of Centre of Advanced Research (CFAR), King George’s Medical University (KGMU), Lucknow, India
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30
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Akbari MR, Mirmohammadsadeghi A, Mahmoudzadeh R, Veisi A. Management of Thyroid Eye Disease-Related Strabismus. J Curr Ophthalmol 2020; 32:1-13. [PMID: 32510007 PMCID: PMC7265261 DOI: 10.1016/j.joco.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/27/2019] [Accepted: 10/10/2019] [Indexed: 01/14/2023] Open
Abstract
Purpose: To review various treatment methods in thyroid eye disease (TED) related strabismus. Methods: We searched in PubMed and Google Scholar and Ovid MEDLINE for keywords including TED-related strabismus, strabismus in thyroid-associated ophthalmopathy, Graves' ophthalmopathy related strabismus or squint, and restrictive strabismus. Two expert strabismus specialists selected and evaluated the English articles that were related to our paper and had been published since 2000. Some articles were added based upon the references of the initial articles. Results: One hundred fifteen articles were found, 98 of which were mostly related to the topic of this review. Management of TED-related strabismus was reviewed and categorized in non-surgical and surgical. Botulinum toxin A (BTA) is a useful non-surgical management of strabismus in an active TED and residual deviation after strabismus surgery. Postoperative under-correction is relatively more common in TED-related esotropia. Lateral rectus resection and BTA are the options to manage the problem. Muscle rectus muscle resection should be performed after maximum recession of restricted muscles. It should be avoided on a restricted or enlarged muscle. Management of TED-related vertical deviation is challenging. In these cases, the surgical treatment selected depends on forced duction test (FDT) (pre and intraoperative), orbital imaging (which muscle is enlarged), and the amount of vertical deviation (in both down-gaze and primary position). Conclusions: TED-related strabismus needs careful evaluation and management to achieve optimal outcome. Different surgical and non-surgical options are available for intervention in TED-related strabismus.
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Affiliation(s)
- Mohammad Reza Akbari
- Eye Research Center, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Mirmohammadsadeghi
- Eye Research Center, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Raziyeh Mahmoudzadeh
- Eye Research Center, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirreza Veisi
- Eye Research Center, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Zhao J, Hodgson NM, Chang JR, Campbell AA, McCulley TJ. Thyroid Eye Disease-Related Epiblepharon: A Comparative Case Study. Asia Pac J Ophthalmol (Phila) 2020; 9:44-47. [PMID: 31990745 PMCID: PMC7004463 DOI: 10.1097/01.apo.0000617916.50176.b2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/21/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study describes the clinical features and management of epiblepharon as a manifestation of thyroid eye disease (TED). In addition, we compare the frequency and age in Asian and non-Asian patients, and discuss pathophysiologic implications. DESIGN Retrospective case-control study. METHODS This is a single-center retrospective review that identified 172 adult patients (age 19 to 83) with TED that were consecutively evaluated by 1 author (T.J.M.) between December 2015 and July 2018. Diagnosis of TED and epiblepharon was based upon clinical assessment as documented in the medical record. RESULTS In a cohort of 172 patients (mean age 52; 138 female), 3 patients with acquired epiblepharon were identified, all of whom were Asian. The proportion of affected Asian patients (3/of 17, 17.6%) was significantly higher than that of non-Asian patients (0/155, P < 0.001). Patients with epiblepharon were also significantly younger than those without epiblepharon, 29.7 ± 2.1 versus 48.7 ± 13 years of age (P = 0.026). All 3 patients underwent surgical correction with lateral canthoplasty and anterior lamellar pretarsal fixation with successful outcomes. CONCLUSIONS Lower eyelid epiblepharon may occur in TED. In our clinic-based population, this finding was significantly more frequent in Asian patients and in younger patients. Relieving horizontal tension in conjunction with anterior lamella pretarsal fixation is an effective method of correcting TED-associated epiblepharon.
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Affiliation(s)
- Jiawei Zhao
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nickisa M Hodgson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessica R Chang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Las Angeles, CA
| | - Ashley A Campbell
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Timothy J McCulley
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Young SM, Lim AYN, Lang SS, Lee KO, Sundar G. Efficacy and safety of pulsed intravenous methylprednisolone in early active thyroid eye disease. Orbit 2019; 38:362-369. [PMID: 30540214 DOI: 10.1080/01676830.2018.1553189] [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: 06/16/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Introduction: The mainstay of therapy for active inflammatory phase of thyroid eye disease (TED) is immunosuppression. Patients in our centre with early active TED are treated with pulsed intravenous methylprednisolone (IVMP). Two different protocols are offered in our centre: High dose (1g/day for 3 days, monthly for 6 months), or EUGOGO protocol (500 mg weekly for six weeks, followed by 250 mg weekly for the next 6 weeks). Methods: A prospective cohort study of patients undergoing the two IVMP protocols was performed from January 2009 to May 2015. Main outcome measures were improvement of Clinical Activity Score (CAS) and International Thyroid Eye Disease (ITEDS) - VISA Inflammatory Index. Results: We had a total of 63 patients. Mean age was 43.1 ± 13.1years, females comprised 49.2% (n = 31), and 31 (49.2%) had a positive smoking history. Following IVMP, 65.0% (n = 41) had good response, 31.7% (n = 20) partial, and 3.3% (n = 2) poor. There were significant differences (p < 0.001) in CAS and ITEDS scores between pre-IVMP and post-IVMP visits, for both protocols. A higher proportion of patients receiving the modified EUGOGO protocol (58.3%) had persistent activity and required additional immunosuppression compared to those who underwent the high dose protocol (33.3%). Mild side effects were experienced by 5 (7.9%) and 3 (4.8%) patients at 3 and 6 months, respectively. There were no severe side effects, cardiovascular events or liver failure. Conclusion: With adequate screening and follow-up, six repeated cycles of high dose pulsed IVMP is an effective treatment for TED and can significantly reduce the morbidity associated with this debilitating condition. None of the 51 patients from the high dose protocol met with any serious side effects.
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Affiliation(s)
- Stephanie M Young
- Division of Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital , Singapore , Singapore
| | - Anita Y N Lim
- Division of Rheumatology, Department of Medicine, National University Hospital , Singapore , Singapore
| | - Stephanie S Lang
- Clinical Audit, Singapore National Eye Centre , Singapore , Singapore
| | - Kok Onn Lee
- Division of Endocrinology, Department of Medicine, National University Hospital , Singapore , Singapore
| | - Gangadhara Sundar
- Division of Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital , Singapore , Singapore
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Lai FHP, Iao TWU, Ng DSC, Young AL, Leung J, Au A, Ko STC, Chong KKL. Choroidal thickness in thyroid-associated orbitopathy. Clin Exp Ophthalmol 2019; 47:918-924. [PMID: 31034694 DOI: 10.1111/ceo.13525] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 12/14/2022]
Abstract
IMPORTANCE To investigate the choroidal thickness (CT) in patients with thyroid-associated orbitopathy (TAO). BACKGROUND To compare CT of TAO patients and healthy subjects. DESIGN Prospective cross-sectional study in a public hospital. PARTICIPANTS One hundred and four eyes of 52 TAO patients and 52 eyes of 26 healthy subjects. METHODS CT was measured with enhanced-depth imaging optical coherence tomography (EDI-OCT) at the subfoveal, macular and peripapillary regions. Multivariate linear regression was used to evaluate the associations of subfoveal CT with systemic and ocular variables among TAO eyes. MAIN OUTCOME MEASURES CT of both groups. RESULTS CT of eyes with TAO was significantly increased at the subfoveal region, 1 and 2 mm from the fovea nasally, temporally and superiorly, and 1 mm inferior to the fovea (all P < .05). No significant difference was found in CT at 2 mm inferior to the fovea (P = .094) and all four quadrants of the peripapillary region (superior, P = .096; nasal, P = .732; inferior, P = .179; temporal, P = .052). Among TAO eyes, thinner subfoveal choroid was associated with worsening exophthalmos (P = .043), poorer visual acuity (P = .017), increasing age (P = .040) and axial length (P < .001). There was no association between CT and clinical activity score (P = .239). CONCLUSIONS AND RELEVANCE TAO patients showed thicker choroid than controls over the macula, but not the peripapillary regions. Thinner subfoveal choroid was associated with worsening exophthalmos and poorer vision. EDI-OCT can monitor choroidal vascular changes associated with TAO and its complications.
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Affiliation(s)
- Frank H P Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Tiara W U Iao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Danny S C Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Joy Leung
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Alvin Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Simon T C Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
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Lee DC, Young SM, Kim YD, Woo KI. Course of upper eyelid retraction in thyroid eye disease. Br J Ophthalmol 2019; 104:254-259. [PMID: 31079052 DOI: 10.1136/bjophthalmol-2018-313578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/25/2019] [Accepted: 04/13/2019] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the natural course of upper eyelid retraction (UER) in patients with thyroid eye disease (TED) and factors affecting its course. METHODS Retrospective non-interventional cohort study in a single tertiary institution from March 2006 to March 2015 on patients with TED with (1) unilateral or bilateral UER within 6 months from initial presentation, and (2) no prior interventions nor surgical treatment for their UER. Main outcomes and measures were mean margin reflex distance 1 (MRD1) and factors associated with UER improvement. RESULTS There were a total of 61 patients and 81 eyes (41 unilateral and 20 bilateral UER). Mean age was 42.3±15.1 years. Mean MRD1 decreased from 6.1 mm at presentation to 4.8 mm at 12 months, and 4.4 mm at 24 months. The proportion of eyes with normalisation of lid height increased from 0% at presentation to 22.2% at 6 months, 37.0% at 12 months and 49.4% at 24 months. Mean time to normalisation of MRD1 was 18.0±12.4 months. A positive family history of TED was found to be associated with a 6.2 times lower likelihood of normalisation. Change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated to change in MRD1 (p<0.05). There was no correlation between change in MRD1 and thyroid-stimulating hormone receptor antibodies. CONCLUSION An improved knowledge of the natural history of UER in TED will allow us to better decide and evaluate the optimal management for such patients.
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Affiliation(s)
- Dong Cheol Lee
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Stephanie M Young
- Ophthalmology, National University Health System, Singapore, Singapore
| | - Yoon-Duck Kim
- Ophthalmology, Samsung Medical Center, Seoul, South Korea
| | - Kyung In Woo
- Ophthalmology, Samsung Medical Center, Seoul, South Korea
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Shin GR, Kim DH. Effect and Prognostic Factors of Systemic Steroid Treatment for Strabismus Associated Thyroid Ophthalmopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.6.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Dae Hyun Kim
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea
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Sun J, Liu X, Zhang Y, Huang Y, Zhong S, Fang S, Zhuang A, Li Y, Zhou H, Fan X. Bovine Acellular Dermal Matrix for Levator Lengthening in Thyroid-Related Upper-Eyelid Retraction. Med Sci Monit 2018; 24:2728-2734. [PMID: 29718902 PMCID: PMC5952806 DOI: 10.12659/msm.909306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Eyelid retraction is the most common and often the first sign of thyroid eye disease (TED). Upper-eyelid retraction causes both functional and cosmetic problems. In order to correct the position of the upper eyelid, surgery is required. Many procedures have demonstrated good outcomes in mild and moderate cases; however, unpredictable results have been obtained in severe cases. Dryden introduced an upper-eyelid-lengthening procedure, which used scleral grafts, but outcomes were unsatisfactory. A new technique is introduced in this study as a reasonable alternative for TED-related severe upper-eyelid retraction correction. Material/Methods An innovative technique for levator lengthening using bovine acellular dermal matrix as a spacer graft is introduced for severe upper-eyelid retraction secondary to TED. Additionally, 2 modifications were introduced: the fibrous cords scattered on the surface of the levator aponeurosis were excised and the orbital fat pad anterior to the aponeurosis was dissected and sutured into the skin closure in a “skin-tarsus-fat-skin” fashion. Results The modified levator-lengthening surgery was performed on 32 eyelids in 26 patients consisting of 21 women and 5 men (mean age, 37.8 years; age range, 19–67 years). After corrective surgery, the average upper margin reflex distance was lowered from 7.7±0.85 mm to 3.3±0.43 mm. Eighteen cases (69%) had perfect results, while 6 cases (23%) had acceptable results. Conclusions A modified levator-lengthening procedure using bovine acellular dermal matrix as a spacer graft ameliorated both the symptoms and signs of severe upper-eyelid retraction secondary to TED. This procedure is a reasonable alternative for correction of TED-related severe upper-eyelid retraction.
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Affiliation(s)
- Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Xingtong Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Yidan Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Yazhuo Huang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Sisi Zhong
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Sijie Fang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Ai Zhuang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (mainland)
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Halliday L, Curragh D, Selva D. Transient bilateral epiblepharon occurring during pregnancy. Clin Exp Ophthalmol 2018; 46:964-965. [PMID: 29700919 DOI: 10.1111/ceo.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Luke Halliday
- Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Curragh
- Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Evaluation of Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in Patients with Active and Inactive Thyroid Orbitopathy. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:26-30. [PMID: 32595367 PMCID: PMC7315080 DOI: 10.14744/semb.2017.07269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Abstract
Objectives: The aim of this study was to evaluate the neutrophil-to-lymphocyte ratio (NLR) and the mean platelet volume (MPV) in patients with active thyroid orbitopathy (TO) and to compare it with that of both healthy subjects and patients with inactive TO. Methods: Twenty patients with active TO (Group 1), 25 patients with inactive TO (Group 2), and 35 age- and sex-matched healthy subjects (Group 3) were included in this study. Patients with other systemic and ocular diseases, patients with a history of intraocular or orbital surgery, and patients using systemic drugs were excluded. The VISA (vision, inflammation, strabismus, appearance) classification scheme was used to discriminate between active and inactive TO. The neutrophil and lymphocyte counts and the MPV of all participants were recorded. The NLR was calculated by dividing the neutrophil count by the lymphocyte count, and the result was compared between groups. The optimal cut-off value was determined for NLR and MPV and the data were compared with a one-way analysis of variance test and the ’Bonferroni post-test. Results: The mean age was 45.4±13.4, 41.0±13.7, and 42.6±14.4 years in Group 1, 2, and 3, respectively (p=0.68). The NLR was 2.11 in Group 1, 1.56 in Group 2, and 1.47 in Group 3 (p=0.03). The ’Bonferroni post-test revealed a difference between Group 1 and Group 2 (p=0.01) and between Group 1 and Group 3 (p<0.001). The MPV was 10.76 fL in Group 1, 9.94 fL in Group 2, and 8.19 fL in Group 3 (p<0.001). The results of the ’Bonferroni post-test showed a difference between Group 1 and Group 2 (p=0.04), between Group 1 and Group 3 (p<0.001), and between Group 2 and Group 3 (p<0.001). The mean cut-off value obtained from receiver operating characteristic (ROC) analysis of NLR was 1.69 (sensitivity: 72%; specificity: 66%). The mean cut-off value obtained from ROC analysis of MPV was 9.95 (sensitivity: 63%; specificity: 66%). Conclusion: High NLR and MPV values may be indicative of active inflammation in patients with TO.”
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Li Q, Ye H, Ding Y, Chen G, Liu Z, Xu J, Chen R, Yang H. Clinical characteristics of moderate-to-severe thyroid associated ophthalmopathy in 354 Chinese cases. PLoS One 2017; 12:e0176064. [PMID: 28472149 PMCID: PMC5417486 DOI: 10.1371/journal.pone.0176064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/05/2017] [Indexed: 12/13/2022] Open
Abstract
Thyroid associated ophthalmopathy (TAO) is an autoimmune inflammatory disorder which disfigures appearance, threatens vision, and results in a pronounced loss of quality of life. The diversity and ethnic difference of the disease manifestations have made it difficult to tailor therapies for each patient. Few studies have analyzed its characteristics in Chinese populations. We therefore enrolled 354 patients with moderate-to-severe TAO from February 2015 to July 2016. A single ophthalmologist consistently performed detailed ophthalmic examinations. Orbital computed tomography or magnetic resonance imaging scans were performed to verify enlarged extraocular muscles. Multiple linear regression was used to analyze the association between sex, age, smoking, family history of thyroid diseases, degree of proptosis and disease severity. The mean age of males (46.56±11.08 years) was significantly higher than that of females (41.39±years), with a female-to-male ratio of 1.09. The females and males between 31~40 and 41~50 years, respectively, had the highest incidence of TAO. 81.48% of the patients suffered hyperthyroidism. TAO was diagnosed either after (47.17%) or simultaneously with thyroid dysfunction (27.68%). Proptosis (91.24%), eyelid retraction (83.33%), together with eyelid swelling (79.38%) and extraocular muscle enlargement (75.42%), were the most common clinical sign. 19.77% of patients manifested lower eyelid retraction. The mean values of exophthalmos and asymmetry on proptosis were 19.94±3.45mm and 2.18±2.06mm, respectively in males, 18.58±3.31mm and 1.61±1.53mm, respectively in females. The severity of disease was significantly associated with male, older age, smoking, family history of thyroid diseases and degree of proptosis. We found several differences in Chinese compared with White. The female-to-male ratio and mean value of exophthalmos were significantly lower than the data of White. Inferior and superior rectus became the most common extraocular muscles. Lower eyelid retraction should be included in diagnostic criteria in Asian patients. Understanding these differences, may allow better identification and treatment for TAO in China.
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Affiliation(s)
- Qian Li
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Huijing Ye
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Yungang Ding
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Qingdao Ludong Eye Hospital, Qingdao, Shandong, P.R. China
| | - Guo Chen
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Zhichang Liu
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Jianan Xu
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Rongxin Chen
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Huasheng Yang
- Zhongshan Ophthalmic Center, State Key laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
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Risk Factors Associated with the Activity and Severity of Graves' Ophthalmopathy among Patients at the University of the Philippines Manila-Philippine General Hospital. J ASEAN Fed Endocr Soc 2017; 32:151-157. [PMID: 33442099 PMCID: PMC7784205 DOI: 10.15605/jafes.032.02.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background Asians with Graves' ophthalmopathy (GO) may have earlier compressive features due to narrower orbital apex and increased orbital volume. Objective To determine the risk factors associated with activity and severity of GO among adults. Methodology This was a cross-sectional analytical study of 163 adults with Graves' disease (GD) from the outpatient clinics of the Philippine General Hospital. Demographics, clinical data, thyrotropin receptor antibody (TRAb) and urine iodine (UIE) levels were obtained. All participants were evaluated for activity and severity of GO by a single ophthalmologist. Results The population was predominantly composed of females (81%) and nonsmokers (69%), with a mean age of 35 + 11 years and median GD duration of 2 years. Median TRAb was 8.9 U/L while UIE was 171 mcg/L. Eight percent exhibited active GO, with 85% having mild disease. Multivariate analysis showed male sex to be associated with severe disease (OR 3.71, p=0.041), while elevated TRAb was associated with both active (OR 1.03, p=0.002) and severe GO (OR 1.02, p=0.007). Conclusion Lower rates of active and severe GO were seen compared to previous reports. In this population of predominantly nonsmokers, elevated TRAb emerged as a risk factor for active and severe GO.
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Huang YM, Chang PC, Wu SB, Kau HC, Tsai CC, Liu CJL, Wei YH. Expression and clinical significance of connective tissue growth factor (CTGF) in Graves' ophthalmopathy. Br J Ophthalmol 2016; 101:676-680. [PMID: 27543288 DOI: 10.1136/bjophthalmol-2016-308713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/18/2016] [Accepted: 07/30/2016] [Indexed: 12/29/2022]
Abstract
AIMS To examine the expression of connective tissue growth factor (CTGF) in human cultured orbital fibroblasts from patients with Graves' ophthalmopathy (GO) and investigate whether a correlation exists between the presence of CTGF protein and clinical parameters of the disease. METHODS The protein expression levels of CTGF were analysed by western blots in cultured orbital fibroblasts from 10 patients with GO and 7 age-matched normal controls. Associations between the protein expression of CTGF and the clinical factors of GO, including clinical demographics, thyroid function, clinical activity score (CAS) and ophthalmopathy index (OI), was evaluated. RESULTS The mean protein expression levels of CTGF in the GO orbital fibroblasts were significantly higher than those of normal controls (p<0.001). Based on further analysis, the protein expression levels of CTGF in the GO orbital fibroblasts had significant correlation with gender (p=0.029), serum levels of thyrotropin receptor antibodies (p=0.029), CAS (p=0.048) and OI (p=0.043). Especially, there was a significant correlation between protein expression levels of CTGF and lid oedema (p=0.037), proptosis (p=0.045) and corneal involvement (p=0.001). CONCLUSIONS Our findings revealed that the protein expression levels of CTGF in the GO orbital fibroblasts were significantly highly expressed than those of normal controls, and the elevated CTGF was associated with clinical characteristics and evolution, indicating CTGF may play a role in the pathogenesis and pathophysiology of GO.
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Affiliation(s)
- Yi-Ming Huang
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Pei-Chen Chang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shi-Bei Wu
- Department of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chuan Kau
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chieh-Chih Tsai
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Yau-Huei Wei
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine and Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
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Ogun OA, Adeleye JO. Severe Ophthalmological Complications of Thyroid Disease are Rare in Ibadan, Southwestern Nigeria: Results of a Pilot Study. OPHTHALMOLOGY AND EYE DISEASES 2016; 8:5-9. [PMID: 27042149 PMCID: PMC4811264 DOI: 10.4137/oed.s32169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ocular manifestations of thyroid dysfunction constitute a wide clinical spectrum ranging from minor ocular discomfort, lid retraction, lid lag and ocular injection, to sight threatening eyeball protusion and optic nerve compression. Thyroid-related eye disorders are most commonly associated with Graves’ disease, and this most frequently occurs in the setting of hyperthyroidism. However, in 10% of cases, typical eye signs have also been reported in euthyroid and hypothyroid states. The severity of thyroid eye disease has been linked to cigarette smoking. There is very little data specifically reporting the ocular manifestations of thyroid disease among black African patients and there is no known report from Nigeria. This pilot study therefore focused on documenting the ocular signs accompanying thyroid dysfunction in a black African population. AIM To evaluate the pattern of ocular complications, among patients treated for thyroid disorders, in a major Nigerian teaching hospital. RESULTS A total of 75 patients with thyroid dysfunction, were evaluated, comprising 63 females and 12 males. There was a very low prevalence of smoking among patients (<5%). Graves’ disease was the commonest thyroid disorder, representing 70% of cases. Seventy-eight percent of patients were hyperthyroid, 11.8% were euthyroid and only 9.8% of patients were hypothyroid. Commonest systemic symptoms were neck swelling (68.6%), weight loss (63.8%), tremors (60.9%) and palpitations (59.4%). Two-thirds of patients reported ocular symptoms consisting mainly of painless eye swelling (66.7%) and ocular irritation (58%). Conjunctival injection, lid lag and lid retraction were the commonest ocular signs. Chemosis, severe proptosis and ocular motility disorder were very rare. Optic neuropathy was found in 4 patients but was related to pre-existing glaucoma. Majority of patients required only ocular emollients and tear supplements. CONCLUSION Severe ocular complications of thyroid disorders were uncommon in this cross-section of Nigerian patients. This may be linked to the very low prevalence of cigarette smoking among Nigerians or genetic and environmental factors linked to their African heritage.
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Affiliation(s)
- Olufunmilola A Ogun
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Jokotade O Adeleye
- Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Choi KJ, Kim SH, Lee JY. Comparison of Patient Characteristics in Thyroid-Associated Ophthalmopathy with and without Strabismus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.10.1610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyung Jun Choi
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seung Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Joo Yeon Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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