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Chien L, Go CC, Lahaie Luna GM, Briceño CA. Changes in choroidal thickness and choroidal vascularity index in thyroid eye disease: a systematic review. Orbit 2024; 43:399-407. [PMID: 36437586 DOI: 10.1080/01676830.2022.2146726] [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: 06/13/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To evaluate the evidence for changes in choroidal thickness and choroidal vascularity index (CVI) in people with thyroid eye disease (TED), stratified by severity, as measured by optical coherence tomography (OCT). METHODS Systematic review, including quality assessment, of published studies investigating choroidal thickness in TED. Outcomes of interest included CVI, subfoveal choroidal thickness, mean choroidal thickness, and peripheral choroidal thickness in four quadrants (superior, inferior, medial, lateral). RESULTS Nineteen studies were included which contained measurements from 1067 eyes in 798 patients with TED. Most studies found an increased CVI and increased choroidal thickness in patients with TED compared to normal controls, especially in the subfoveal region. In addition, several studies reported an increased thickness in patients with active vs. inactive TED, although the results are equivocal. Finally, many studies reported associations between increased choroidal thickness and worsened clinical measurements of disease activity, such as Clinical Activity Score (CAS). CONCLUSIONS This systematic review provided evidence for an association between increased CVI/choroidal thickness and TED, suggesting a potential for OCT-measured CVI/choroidal thickness as an objective clinical marker. Given heterogeneity, future studies are needed to assess the role of measuring the choroidal changes in diagnosis and management of TED.
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Affiliation(s)
- Lillian Chien
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cammille C Go
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gabriela M Lahaie Luna
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - César A Briceño
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kowalik-Jagodzińska M, Sobol M, Turno-Kręcicka A. A Comparison of Observational Studies on Subfoveal Choroidal Thickness Measured with OCT according to the Level of Thyroid Eye Disease Activity-Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4720. [PMID: 37510836 PMCID: PMC10380986 DOI: 10.3390/jcm12144720] [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: 05/30/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This study aims to systematise subfoveal choroidal thickness (SFCT) measured using optical coherence tomography (OCT) in patients with different severities of thyroid eye disease (TED) compared with healthy subjects. The PubMed, Web of Science and Scopus databases were searched for the following terms: ((Graves' ophthalmopathy) OR (thyroid eye disease) OR (Graves' orbitopathy) OR (thyroid-associated orbitopathy)) AND (choroidal thickness) AND ((optical coherence tomography) OR (OCT)). The pool of papers was narrowed down to articles published until 31 January 2023 (26, 26 and 96 papers, respectively). Twenty-five (25) articles were taken into consideration, which were original papers and included the choroidal thickness measurements among TED patients in their results. Finally, eight papers were included in the comparative analysis of the SFCT parameter in TED patients and a group of healthy controls, and seven papers in the comparative analysis of the same parameter between active and inactive TED patients. The mean value of the difference between the TED group and the healthy group was 38.79 μm, with a confidence interval (CI) from 0.09 to 77.49 μm (p = 0.0495). The mean difference between the active TED group and inactive TED group was 38.02 μm, with a CI from 8.62 to 67.42 μm (p = 0.0113). All the results were statistically significant.
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Affiliation(s)
| | - Maria Sobol
- Department of Biophysics Physiology and Pathophysiology, Medical University of Warsaw, 02-004 Warszawa, Poland
| | - Anna Turno-Kręcicka
- Department of Ophthalmology, Wroclaw Medical University, 50-367 Wrocław, Poland
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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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Assessment of Choroidal Vascularity in Inactive Thyroid Associated Orbitopathy. BEYOGLU EYE JOURNAL 2023; 8:38-44. [PMID: 36911212 PMCID: PMC9993418 DOI: 10.14744/bej.2022.04900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
Abstract
Objectives The objectives of the study were to evaluate the vascular and stromal structure of the choroid in patients with inactive thyroid associated orbitopathy (TAO) by measuring choroidal vascularity index (CVI) and choroidal thickness (CT) using enhanced depth imaging (EDI) optical coherence tomography (OCT). Methods The choroidal image was taken with EDI mode spectral domain (SD)-OCT. All scans were taken between 9.30 am and 11.30 am to avoid the diurnal variation of CT and CVI. To calculate CVI, macular SD-OCT scans were binarized using the publicly available software ImageJ and luminal area and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. Furthermore, the relation between CVI and axial length, gender, and age was evaluated. Results This study included 78 individuals with a mean age of 51.4±7.3 years. Group 1 consisted of 44 patients with inactive stage TAO, and Group 2 consisted of 34 healthy controls. Subfoveal CT was 338.92±73.93 µm in Group 1 and 303.97±40.35 µm in Group 2 (p=0.174). The CVI significantly differed between the two groups, which was higher in group 1 (p=0.000). Conclusion Although CT was not different between groups, CVI which is the indicator of the vascular status of the choroid, was higher in patients with TAO in the inactive stage compared with healthy control subjects.
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Biçer GY, Zor KR, Biçer KE, Küçük E, Küçük EB. Can the long term using of pregabalin in fibromyalgia affect the choroid and retinal nerve fiber layer? Eye (Lond) 2022; 36:2318-2322. [PMID: 34857924 PMCID: PMC9674638 DOI: 10.1038/s41433-021-01864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In this study, the effects of long-term pregabalin use on the choroid and retinal nerve fiber layer were investigated in the fibromyalgia disease. METHODS The patient group consisted of 41 fibromyalgia patients using pregabalin. The control group consisted of 41 newly diagnosed fibromyalgia patients who had not received any treatment yet. Choroidal and retinal nerve fiber layer thickness measurements were performed with Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA) 30 minutes after pupil dilation with 1% tropicamide. RESULTS There was no difference in subfoveal choroidal thickness, nasal choroidal thickness and temporal choroidal thickness between the patient and control groups (p > 0.05). Increasing the duration of drug use within the patient group was found to thin the retinal nerve fiber layer (p < 0.05). CONCLUSION We found that pregabalin had no effect on the choroid, while it had a thinning effect for retinal nerve fiber layer. It is recommended not to be preferred pregabalin in fibromyalgia patients with retinal nerve fiber layer damage such as diabetic retinopathy and glaucoma. Patients treated with pregabalin should have regular control in the ophthalmology clinic.
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Affiliation(s)
- Gamze Yıldırım Biçer
- Niğde Ömer Halisdemir University School of Medicine Department of Ophthalmology, Niğde, MD, Turkey.
| | - Kürşad Ramazan Zor
- Niğde Ömer Halisdemir University School of Medicine Department of Ophthalmology, Niğde, MD, Turkey
| | - Kadir Eren Biçer
- Niğde Ömer Halisdemir Education and Research Hospital Department of Orthopedics and Traumatology, Niğde, MD, Turkey
| | - Erkut Küçük
- Niğde Ömer Halisdemir University School of Medicine Department of Ophthalmology, Niğde, MD, Turkey
| | - Esin Benli Küçük
- Niğde Bor Physical Medicine and Rehabilitation Hospital Department of Physical Medicine and Rehabilitation, Niğde, MD, Turkey
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Aksoy M, Simsek M, Apaydın M. Evaluation of choroidal circulation and stromal features in Graves' disease. Eur J Ophthalmol 2021; 32:1680-1686. [PMID: 34250837 DOI: 10.1177/11206721211031406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate choroidal thickness (CT) and choroidal vascularity index (CVI) in patients with Graves' disease (GD) without ocular involvement. METHODS Fifty patients diagnosed with GD and 50 age and gender matched healthy control subjects were retrospectively evaluated. Measurements were taken from five different points on CT images. Choroid images were classified as lumen regions (LA) and stromal regions (SA) using the image binarization method. CVI was calculated by dividing LA by the total choroidal area (TCA). The effects of Thyrotropin Receptor Antibody (TRAb), age, GD duration, blood pressure, axial length measurements, and intraocular pressure were analyzed on CT and CVI measurements. RESULTS Mean age was 40.1 ± 13.5 years in the patient group and 39.3 ± 13.6 years in the control group (p = 0.89). There was no significant difference between the GD group and control group in terms of CT measurements. There was a significant difference between the mean CVI measurements of the GD group and control group (68.03 ± 3.41 and 66.62 ± 3.11, respectively) (p < 0.001). Univariate linear regression analysis revealed a positive correlation between TRAb and CVI (p = 0.013). CONCLUSION While there was no significant difference between the CT measurements of the GD group and the control group, the GD group had significantly higher CVI measurements.
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Affiliation(s)
- Mustafa Aksoy
- Department of Ophthalmology, Yuksek Ihtisas University, Ankara, Turkey
| | - Mert Simsek
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Mahmut Apaydın
- Department of Endocrinology and Metabolism, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Zor KR, Yıldırım Biçer G, Tutaş Günaydın N, Küçük E, Yılmaz U. Can the coronavirus disease 2019 (COVID-19) cause choroiditis and optic neuropathy? EUR J INFLAMM 2021. [DOI: 10.1177/20587392211059060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: We aim to investigate the involvement of the choroid and retinal nerve fiber layer (RNFL) in COVID-19 patients using spectral domain optical coherence tomography. Methods: This cross-sectional study was conducted between April and June 2020. 40 patients (23 female and 17 male) with COVID-19 and 42 healthy individuals (26 female and 16 male) were included in the study. The OCT scans were performed 4 weeks after the COVID-19 diagnosis. Results: In the COVID-19 group, in the right eyes, the mean nasal choroidal thickness was 295.70 ± 7,046 μm ( p = 0.017), mean subfoveal choroidal thickness was 333.25 ± 6,353 μm ( p = 0.003), mean temporal choroidal thickness was 296.63 ± 6,324 μm ( p = 0.039), and mean RNFL was 89.23 ± 1.30 μm ( p = 0.227). In the left eyes, mean nasal choroidal thickness was 287.88 ± 9,033 μm ( p = 0.267), mean subfoveal choroidal thickness was 333.80 ± 9,457 μm ( p = 0.013), mean temporal choroidal thickness was 298.50 ± 9,158 μm ( p = 0.079), and mean RNFL was 89.48 ± 1,289 μm ( p = 0.092). Compared with the control group, the patient group had significant thickening of the choroidal thickness in all quadrants of the right eyes, and significant thickening of the subfoveal choroidal thickness in the left eyes. There was no significant difference in the RNFL thickness between groups ( p > 0.05). Conclusion: COVID-19 may cause a subclinical involvement in the choroidal layer.
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Affiliation(s)
- Kürşad Ramazan Zor
- Department of Ophthalmology, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Gamze Yıldırım Biçer
- Department of Ophthalmology, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Nesrin Tutaş Günaydın
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Erkut Küçük
- Department of Ophthalmology, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Uğur Yılmaz
- Department of Ophthalmology, School of Medicine, Pamukkale University, Denizli, Turkey
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