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Hilliard G, Pruett J, Donahue SP, Velez FG, Peragallo JH, Ditta LC, Tavakoli M, Hoehn ME, Kuo AF, Indaram M, Kerr NC. Outcomes of Strabismus Surgery Following Teprotumumab Therapy. Am J Ophthalmol 2024; 262:186-191. [PMID: 38191066 DOI: 10.1016/j.ajo.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
PURPOSE To investigate the results of patients undergoing surgical treatment for strabismic diplopia in thyroid eye disease (TED) following teprotumumab. DESIGN Multicenter, retrospective, case series. METHODS We report 28 patients who underwent extraocular muscle surgery for strabismic diplopia after treatment with teprotumumab at 7 different academic centers. Elapsed time from last teprotumumab dose to the date of surgery, previous orbital decompression, primary preoperative horizontal and vertical deviation, surgical procedure, and 2-month postoperative results were collected from the patient records. RESULTS Sixteen (57%) patients were diplopia-free after 1 surgery. Three (11%) chose prism spectacles to correct residual diplopia, 2 (7%) used compensatory head posture to resolve diplopia, and 1 (4%) had intermittent diplopia and was functionally improved (choosing no prisms or further surgery). These were considered treatment successes. Three (11%) patients required reoperation, and all were diplopia-free after their second procedure. CONCLUSIONS Most patients requiring surgery for strabismic diplopia following teprotumumab achieve good outcomes with success rates comparable to series published before the availability of teprotumumab.
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Affiliation(s)
- Grant Hilliard
- From the Department of Ophthalmology, Hamilton Eye Institute, The University of Tennessee Health Science Center (G.H., L.C.D, M.E.H., N.C.K.), Memphis, Tennessee
| | - Jaron Pruett
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center (J.P., S.P.D.), Nashville, Tennessee
| | - Sean P Donahue
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center (J.P., S.P.D.), Nashville, Tennessee
| | - Federico G Velez
- Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles (F.G.V.), Los Angeles, California; Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles (F.G.V.), Los Angeles, California
| | - Jason H Peragallo
- Departments of Ophthalmology and Pediatrics, Emory University School of Medicine (J.H.P.), Atlanta, Georgia
| | - Lauren C Ditta
- From the Department of Ophthalmology, Hamilton Eye Institute, The University of Tennessee Health Science Center (G.H., L.C.D, M.E.H., N.C.K.), Memphis, Tennessee
| | - Mehdi Tavakoli
- Department of Ophthalmology, George Washington University School of Medicine and Health Sciences (M.T.), Washington, District of Columbia
| | - Mary E Hoehn
- From the Department of Ophthalmology, Hamilton Eye Institute, The University of Tennessee Health Science Center (G.H., L.C.D, M.E.H., N.C.K.), Memphis, Tennessee
| | - Annie F Kuo
- Department of Ophthalmology, Oregon Health & Science University (A.F.K.), Portland, Oregon
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco Health (M.I.), San Francisco, California, USA
| | - Natalie C Kerr
- From the Department of Ophthalmology, Hamilton Eye Institute, The University of Tennessee Health Science Center (G.H., L.C.D, M.E.H., N.C.K.), Memphis, Tennessee.
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Ma L, Wang M, Zhang Z, Jiang X, Hou Z, Li D. Three-dimensional soft tissue reconstruction and volume measurement used for the diagnosis of dysthyroid optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2024; 262:1919-1924. [PMID: 38294512 DOI: 10.1007/s00417-023-06355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Dysthyroid optic neuropathy (DON) leads to vision loss. This study aimed to investigate a new method that can directly evaluate the change in muscle cone inner volume (MCIV) and distinguish DON orbits from non-DONs. MATERIALS AND METHODS This study included 54 patients (108 orbits) who were diagnosed with thyroid eye disease and treated at the Beijing Tongren Hospital between December 2019 and September 2021. The extraocular muscle volume (EOMV), orbital fat volume (OFV), and bony orbit volume (BOV) of the patients were measured using three-dimensional reconstruction. MCIV was measured using artificially defined boundaries. The associations between these volumes and clinical indicators were studied, and the diagnostic efficacy of these volumes for DON was described using receiver operating characteristic (ROC) curves. RESULTS The ROC curve showed that the area under the curve of MCIV/BOV (%) combined with EOMV/BOV (%) reached 0.862 (p < 0.001), with a sensitivity of 85.7% and a specificity of 76.1%. CONCLUSION The combination of MCIV/BOV (%) and EOMV/BOV (%) is a good indicator for the diagnosis of DON, which aids in the early detection and intervention of DON.
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Affiliation(s)
- Lan Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, No.1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Minghui Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, No.1 Dong Jiao Min Xiang, Beijing, 100730, China
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Zheng Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, No.1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Xue Jiang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, No.1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Zhijia Hou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, No.1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Dongmei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, No.1 Dong Jiao Min Xiang, Beijing, 100730, China.
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Hubschman S, Sojitra B, Ghiam S, Sears C, Hwangbo N, Goldberg RA, Rootman DB. Teprotumumab and Orbital Decompression for the Management of Proptosis in Patients With Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2024; 40:270-275. [PMID: 37972968 DOI: 10.1097/iop.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare outcomes of patients with thyroid eye disease treated with teprotumumab or orbital decompression, or both in sequence. METHODS Patients with thyroid eye disease and treated with decompression, teprotumumab, or both were included. Four groups were defined: decompression only, teprotumumab only, teprotumumab first with decompression later, and decompression first with teprotumumab later. The primary outcome was change in exophthalmometry. Secondary outcomes included change in extraocular muscle motility, strabismus, diplopia, and side effects. RESULTS One hundred and thirty-nine patients were included. The mean duration for early follow-up was 1.2 months for both decompression and teprotumumab groups. The mean late follow-up was 14.4 and 8.2 months for the decompression and teprotumumab groups respectively. Mean change in exophthalmometry was significantly greater for the decompression group (3.5 mm) compared with teprotumumab (2.0 mm) at late follow-up. Improvement in total extraocular muscle restriction was significantly greater in the teprotumumab group (14.7 degrees) than in the decompression group (2.6 degrees). The teprotumumab group had a significantly higher percentage of patients with diplopia score >1 at baseline and late follow-up ( p < 0.01) compared with the decompression group. Additional treatment with teprotumumab or decompression when previously treated with the opposite had similar proptosis reduction effect as that therapy alone. CONCLUSIONS Surgical decompression has a greater proptosis reduction effect than teprotumumab, whereas teprotumumab better improves extraocular muscle motility. The addition of teprotumumab or decompression to a previous course of the opposite adds a similar effect to the supplemental treatment alone.
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Affiliation(s)
- Sasha Hubschman
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Badal Sojitra
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Sean Ghiam
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Connie Sears
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Nathan Hwangbo
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
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Ting MAJ, Topilow NJ, Ediriwickrema LS, Yoon JS, Liu CY, Korn BS, Kikkawa DO. A comparison of proptosis reduction with teprotumumab versus surgical decompression based on fat-to-muscle ratio in thyroid eye disease. Orbit 2024; 43:222-230. [PMID: 37978819 DOI: 10.1080/01676830.2023.2282509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To explore if orbital fat-to-muscle ratio (FMR) is predictive of whether surgical decompression or teprotumumab leads to greater proptosis reduction in thyroid eye disease (TED). METHODS A single-center retrospective cohort study comparing surgical decompression with teprotumumab according to FMR. All TED patients completing an 8-dose course of teprotumumab between January 2020 and September 2022 and all patients undergoing bony orbital decompression from January 2017 to December 2019 were included. Subjects were excluded if they were <18 years, received both surgical decompression and teprotumumab, or lacked orbital imaging. The primary exposure variable was teprotumumab or surgical decompression. The secondary exposure variable was baseline FMR. The primary outcome measure was change in proptosis (mm). RESULTS Thirty-eight patients, mean age 53.5 years (±11.4), were included in the teprotumumab group and 160 patients, mean age 48 years (±11.1), in the surgical group. Average proptosis reduction after teprotumumab and surgical decompression was 3 mm (±1.44) and 5 mm (±1.75), respectively. The FMR was stratified at the median of 1.80. In subjects with FMR < 1.80, teprotumumab showed equivalent proptosis reduction compared to surgical decompression, -0.33 mm (SE 1.32) p = .802. In subjects with FMR ≥ 1.80, surgical decompression led to significantly more proptosis reduction than teprotumumab, 3.01 mm (SE 0.54), p < .001. CONCLUSIONS Baseline FMR can be used to counsel patients as to proptosis reduction with teprotumumab versus surgery. Subjects with low FMR obtain comparable proptosis reduction with teprotumumab or surgery, whereas high FMR is associated with more significant proptosis reduction following surgery over teprotumumab.
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Affiliation(s)
- Michelle A J Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
| | - Lilangi S Ediriwickrema
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, USA
| | - Jin Sook Yoon
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, San Diego, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, San Diego, California, USA
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Yu J, Sang Z, Ren Z, Xu Q, Wang Y, Liao H. Initial implementation of surgical guide design utilizing digital medicine for lateral orbital decompression surgery. J Craniomaxillofac Surg 2024; 52:432-437. [PMID: 38448333 DOI: 10.1016/j.jcms.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/12/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
This study aimed to assess the feasibility of utilizing a surgical guide, designed through digital medical technology, in lateral orbital decompression surgery. METHODS: In total, 18 patients with thyroid-associated ophthalmopathy (TAO), who underwent orbital balance decompression surgery at the Affiliated Eye Hospital of Nanchang University between September 2018 and August 2022, were included. Orbital CT scanning was performed on all patients with TAO, and Mimics 21.0 software was used to reconstruct a three-dimensional model of the orbit based on the CT data. The osteotomy guide plate for lateral orbital decompression surgery was designed using 3-matic 13.0 software, adhering to the criteria of surgical effectiveness and safety. The surgical positioning guide was designed using Geomagic Wrap 21.0. Once printed, the surgical guide was sterilized with low-temperature plasma and applied during surgery. Of the nine patients treated using a surgical navigation system, three cases experienced cerebrospinal fluid leakage complications during the procedure, and two exhibited inadequate bone removal along the lateral wall. In contrast, among the nine patients treated with surgical guides, no intraoperative cerebrospinal fluid leakage or evidence of insufficient lateral wall bone removal was observed, highlighting a statistically significant distinction between the two cohorts (p = 0.046). Postoperative improvements were notable in best-corrected visual acuity (BCVA) and exophthalmos for patients afflicted with extremely severe TAO. The surgical guide, designed with digital medical technology, has been shown to be an effective and secure auxiliary tool in lateral orbital decompression surgery. It not only aids in reducing the incidence of intraoperative complications, but also enhances the accuracy and safety of surgery. These improvements offer robust support for continued exploration in this field within clinical practice.
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Affiliation(s)
- Jinhai Yu
- School of Optometry, Jiangxi Medical College, Nanchang University, China; Jiangxi Research Institute of Ophthalmology and Visual Science, China; Jiangxi Provincial Key Laboratory for Ophthalmology, China
| | - Zexi Sang
- School of Optometry, Jiangxi Medical College, Nanchang University, China; Jiangxi Research Institute of Ophthalmology and Visual Science, China; Jiangxi Provincial Key Laboratory for Ophthalmology, China
| | - Zhangjun Ren
- School of Optometry, Jiangxi Medical College, Nanchang University, China; Jiangxi Research Institute of Ophthalmology and Visual Science, China; Jiangxi Provincial Key Laboratory for Ophthalmology, China
| | - Qihua Xu
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Research Center for Ophthalmic Disease, China
| | - Yaohua Wang
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Research Center for Ophthalmic Disease, China.
| | - Hongfei Liao
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Research Center for Ophthalmic Disease, China.
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Roda M, Valsecchi N, di Geronimo N, Repaci A, Vicennati V, Pagotto U, Fresina M, Fontana L, Schiavi C. Long-term surgical outcome and impact on daily life activities of strabismus surgery in thyroid-associated ophthalmopathy with and without previous orbital decompression. Head Face Med 2024; 20:22. [PMID: 38561852 PMCID: PMC10983756 DOI: 10.1186/s13005-024-00423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUNDS To report the long-term surgical outcomes and the impact on daily life activities of strabismus surgery in patients with Thyroid Associated Orbitopathy (TAO) with and without previous orbital decompression. METHODS Patients who underwent strabismus surgery for TAO were retrospectively reviewed. The primary outcome was to evaluate the influence of orbital decompression on the outcomes of TAO related strabismus surgery. Surgical success was defined by the resolution of diplopia and a post-operative deviation < 10 prism diopters (PD). The secondary outcomes were the clinical features, surgical approaches, and impact on daily life activities. RESULTS A total of 45 patients were included in the study. The decompression surgery group (DS) included 21 patients (46.7%), whereas the non-decompression surgery group (NDS) patients were 24 (53.3%). The mean follow-up time from the last strabismus surgery was 2,8 years (range 8-200 months). Successful surgical outcome was achieved in 57,1% of patients in the DS, and 75% of patients in the NDS (p = 0,226). DS patients required almost twice the number of surgical interventions for strabismus compared to the NDS (1,95 vs. 1,16 respectively, p = 0,006), a higher number of extraocular muscles recessed in the first surgery (2,67 vs. 1,08 respectively, p < 0.001), and a lower rate of unidirectional surgery compared to NDS (23% vs. 95%, p < 0,001). At the pre-operative assessment, 71.4% of DS patients had eso-hypotropia, while no patients had this type of strabismus in the NDS group (p < 0.001). On the other hand, the hypotropia rate was 79.2% in NDS patients and only 4.8% in DS patients (p < 0.001). Moreover, 21,8% of NDS patients used prism lenses in daily life activities, compared to 42.9% of patients that used prism lenses to reduce the impairment in their daily life activities (p = 0.016). CONCLUSIONS The results of our study showed that DS patients required almost twice the number of strabismus surgical procedures, a higher number of extraocular muscles recessed in the first surgery, and an increased need for prism lenses to correct the residual deviation compared to the NDS, but with similar long-term surgical outcomes.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Nicola Valsecchi
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Natalie di Geronimo
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Repaci
- Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Valentina Vicennati
- Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Uberto Pagotto
- Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Michela Fresina
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Fontana
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Costantino Schiavi
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Rana K, Madike R, Leyden J, Slattery J, Chan WO, Simon S, Patel S, Selva D. Optic nerve sheath infiltration in dysthyroid optic neuropathy. Eye (Lond) 2024; 38:1173-1175. [PMID: 38012386 PMCID: PMC11009224 DOI: 10.1038/s41433-023-02857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/04/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To assess the association of optic nerve sheath (ONS) infiltration, fat infiltration, and scleral enhancement with active thyroid eye disease (TED) and dysthyroid optic neuropathy (DON). METHODS Thyroid eye disease patients who had axial and coronal fat-suppressed contrast enhanced T1-weighted magnetic resonance imaging (MRI) imaging performed were included. Optic nerve sheath infiltration was defined by the presence of thickening and circumferential enhancement of the optic nerve sheath. Clinical assessments were performed by orbital surgeons or neuro-ophthalmologists and the disease activity (active/inactive) and presence or absence of dysthyroid optic neuropathy were recorded. RESULTS The study population consisted of 76 orbits from 38 patients with a mean age of 53 ± 15 years, with 25 (66%) being female. Optic nerve sheath infiltration was present in 28 (37%) orbits, fat infiltration in 37 (49%) and scleral enhancement in 14 (18%) orbits. ONS infiltration (OR 19.8, p < 0.01), fat infiltration (OR 5.2, p < 0.01) and scleral enhancement (OR 12.2, p = 0.01) were all significantly associated with active clinical disease. Patients with ONS infiltration had a significantly higher odds of dysthyroid optic neuropathy (OR 3.4, p < 0.05). Fat infiltration (OR 2.8, p = 0.1) and scleral enhancement (OR 2.3, p = 0.23) were not significantly associated with DON. CONCLUSIONS Optic nerve sheath infiltration may be a predictor of dysthyroid optic neuropathy. Intraorbital fat infiltration and scleral enhancement may be used to detect active TED. These radiological findings may serve as useful diagnostic and stratification tools in evaluating TED patients.
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Affiliation(s)
- Khizar Rana
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Reema Madike
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - James Leyden
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - James Slattery
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Weng Onn Chan
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Sumu Simon
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Dinesh Selva
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
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Sobti M, Brogan K, Patel R, Miller D, Chadha V, Cauchi P. Impact of sphenoid trigone size and extraocular muscle thickness on the outcome of lateral wall orbital decompression for thyroid eye disease. Oral Maxillofac Surg 2024; 28:307-313. [PMID: 36813910 DOI: 10.1007/s10006-023-01143-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND To retrospectively review lateral wall orbital decompression for thyroid eye disease (TED) and to evaluate pre-operative CT scans to analyse the variation in proptosis reduction. METHODS Consecutive lateral wall orbital decompressions performed by a single surgeon were retrospectively reviewed. Pre-operative CT scan features and post-operative proptosis reduction were analysed. The sphenoid trigone cross-sectional areas were summed and multiplied by the slice thickness to yield bone volume. Cumulative extraocular muscle thickness was calculated by combining the maximum thickness of the four recti. "Trigone volume" and "cumulative muscle thickness" were correlated with proptosis reduction at 3 months post-surgery. RESULTS Out of 73 consecutive lateral wall orbital decompressions, 17 orbits had prior endonasal medial wall orbital decompression. In the remaining 56 orbits, the mean pre-operative and post-operative proptosis were 24.3 ± 1.6 mm and 20.9 ± 2.3 mm respectively. The proptosis reduction ranged from 1 to 7 mm (mean of 3.5 mm ± 1.3 (p < 0.001)). Mean sphenoid trigone volume was 895 ± 434.4 mm3. The mean cumulative muscle thickness was 20.4 ± 5 mm. The correlation coefficient between muscle thickness and proptosis reduction was - 0.3 and was statistically significant (p = 0.043). The correlation coefficient between sphenoidal trigone volume and proptosis reduction was 0.2 (p = 0.068). With a multivariate analysis, the coefficient of efficient of regression for muscle thickness was - 0.007 (p = 0.42) and the coefficient of regression for trigone volume was 0.0 (p = 0.046). CONCLUSION Proptosis reduction following lateral wall orbital decompression can be variable. Extraocular muscle thickness had a significant correlation with the outcome, with greater proptosis reduction in orbits with thin muscles. The sphenoidal trigone size had a weak correlation with decompression outcome.
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Affiliation(s)
- Manvi Sobti
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK.
| | - Kerr Brogan
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - Radhika Patel
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - David Miller
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - Vikas Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - Paul Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
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Jinhai Y, Yunxiu C, Chao X, Yaohua W, Kai Y, Hongfei L. A meta-analysis of the efficacy of two-wall orbital decompression operations for thyroid-associated ophthalmopathy. Int Ophthalmol 2024; 44:81. [PMID: 38358400 DOI: 10.1007/s10792-024-03039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The main treatment for the symptoms of proptosis and optic nerve compression caused by thyroid-associated ophthalmopathy is orbital decompression surgery. Medial inferior wall decompression and balanced decompression are two frequently used surgical procedures. However, there is no unified consensus on how to choose different surgical options for orbital decompression in clinical practice. AIMS To compare the effects of medial inferior wall decompression and balanced decompression surgery through meta-analysis and to provide reference for clinical optimal decision making. METHODS Databases, including PubMed, Web of Science, Ovid, Cochrane Library, and ClinicalTrials.gov, were searched for randomized controlled trials and cohort studies on decompression surgery for thyroid-associated ophthalmopathy published from inception to March 21, 2023. Using RevMan 5.3 software, a meta-analysis was conducted based on the following outcome indicators: proptosis, diplopia rate, intraocular pressure, visual acuity, and complication rate. RESULTS Two randomized controlled trials and five cohort studies with a total of 377 patients were included in this analysis. After balanced decompression surgery, patients with thyroid-associated ophthalmopathy experienced a significant decrease in proptosis [MD = 4.92, 95% CI (4.26, 5.58), P < 0.0001]. Balanced decompression can improve postoperative visual acuity [MD = - 0.35, 95% CI (- 0.56, - 0.13), P = 0.001] and intraocular pressure [MD = 5.33, 95% CI (3.34, 7.32), P < 0.0001]. The rates of proptosis [MD = 0.33, 95% CI (- 1.80, 2.46), P = 0.76] and diplopia [OR = 1.20, 95% CI (0.38, 3.76), P = 0.76] did not differ between patients who underwent medial inferior wall decompression and those who underwent balanced decompression. CONCLUSION Balanced decompression and medial inferior wall decompression are both effective options for surgical treatment of thyroid-associated ophthalmopathy in clinical practice.
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Affiliation(s)
- Yu Jinhai
- School of Optometry, Jiangxi Medical College, Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang, China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, China
| | - Chen Yunxiu
- School of Optometry, Jiangxi Medical College, Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang, China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, China
| | - Xiong Chao
- School of Optometry, Jiangxi Medical College, Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang, China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, China
| | - Wang Yaohua
- The Affiliated Eye Hospital, Jiangxi Medical College Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang, China.
| | - Yuan Kai
- The Affiliated Eye Hospital, Jiangxi Medical College Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang, China
| | - Liao Hongfei
- The Affiliated Eye Hospital, Jiangxi Medical College Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang, China.
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Chung CY, Ko TC, Wei YH, Liao SL. Long-term outcomes of inferomedial orbital wall decompression in Graves' ophthalmopathy in an Asian population: A 30-year retrospective study. Indian J Ophthalmol 2024; 72:S233-S239. [PMID: 38271419 DOI: 10.4103/ijo.ijo_863_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/10/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE This study aims to evaluate the long-term outcomes of inferomedial orbital wall decompression (IMOD) in Graves' ophthalmopathy (GO). METHODS A retrospective review of 422 eyes of 226 patients with GO-related cosmetically disfiguring proptosis (COS), dysthyroid optic neuropathy (DON), or exposure keratopathy (EXP) who received IMOD from 1989 to 2020 was conducted. Hertel value (HE) and corrected visual acuity (CVA) were evaluated at baseline and regularly thereafter. Proptosis recurrence, diplopia, and adjuvant surgeries were assessed. Complete success was defined as proptosis reduction over 2 mm without recurrence and improved diplopia. Partial success was defined as proptosis reduction without recurrence but with persistent or new-onset diplopia, and failure as proptosis recurrence. RESULTS After follow-up for 40.1 ± 39.6 months (range, 6-239 months), 236 eyes (55.9%) achieved complete success, 175 eyes (41.5%) achieved partial success, and 11 eyes (2.6%) had failure. Significant CVA improvement was observed in both DON and COS groups (P < 0.001 and P = 0.045, respectively). Average proptosis reduction was 5.2 ± 2.2 mm, with a significant increase of 0.5 mm after long-term follow-up (P < 0.001). Incidence of proptosis recurrence was 2.6%. Surgical success rate of COS group was positively correlated with preoperative HE. CONCLUSION IMOD demonstrated excellent success rate in all three subgroups with a low proptosis recurrence rate and improved visual outcome in both DON and COS groups. Delayed proptosis reduction effect of IMOD may result in delayed-onset asymmetry, especially in the unilateral group.
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Affiliation(s)
- Chu-Ying Chung
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Chieh Ko
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Meunier A, Haissaguerre M, Majoufre C, Schlund M. Surgical management of dysthyroid optic neuropathy: A systematic review. J Stomatol Oral Maxillofac Surg 2024; 125:101616. [PMID: 37666483 DOI: 10.1016/j.jormas.2023.101616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE There is currently no recommendation on the optimal surgical management for dysthyroid optic neuropathy (DON). The aim of this study is to systematically review the surgical management of DON and its outcome on visual acuity (VA). DATA SOURCES MEDLINE, Cochrane Library, and clinicaltrials.gov REVIEW METHODS: A systematic review of studies about the surgical management of DON was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if preoperative and postoperative VA in logMAR (Logarithm of the Minimum Angle of Resolution) were available. RESULTS Fifteen articles were included in the study accounting for 669 orbits. The mean VA improvement was of 0.44 logMAR overall, 0.41 logMAR for 1-wall, 0.41 logMAR for 2-wall, and 0.55 logMAR for 3-wall decompressions. The mean reduction in exophthalmos was 4.9 mm overall, 4.3 mm for 1-wall, 4.54 mm for 2-wall, and 6.02 for 3-wall decompressions. The mean new onset diplopia (NOD) rate was 19.84% overall, 19,12% for 1-wall, 20.75% for 2-wall, and 19.83% for 3-wall decompressions. CONCLUSION The results are limited due to the high number of biases in the included studies. It seems that 3-wall decompression offers the best VA improvement and proptosis reduction although also the highest NOD and complications rate. Two-wall balanced decompression or 1-wall inferomedial decompression seems to be effective with less morbidity.
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Affiliation(s)
- A Meunier
- Univ. Bordeaux, CHU Bordeaux, Service de Chirurgie Maxillo-Faciale et Stomatologie, F-33000 Bordeaux, France.
| | - M Haissaguerre
- Univ. Bordeaux, CHU Bordeaux, Service d'Endocrinologie et Oncologie Endocrinienne, F-33000 Bordeaux, France
| | - C Majoufre
- Univ. Bordeaux, CHU Bordeaux, Service de Chirurgie Maxillo-Faciale et Stomatologie, F-33000 Bordeaux, France
| | - M Schlund
- Univ. Bordeaux, CHU Bordeaux, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1026 - Bioengineering of Tissues, F-33000 Bordeaux, France
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Byeon HJ, Ko J, Kikkawa DO, Yoon JS. Preoperative Risk Factors for Proptosis Recurrence After Rehabilitative Orbital Decompression in Graves' Orbitopathy Patients. Am J Ophthalmol 2024; 258:110-118. [PMID: 37544496 DOI: 10.1016/j.ajo.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/08/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Rehabilitative orbital decompression treats disfiguring exophthalmos in patients with Graves' orbitopathy (GO). This study aimed to identify risk factors associated with the postoperative recurrence of proptosis after orbital decompression. DESIGN Retrospective, case-control study. METHODS This retrospective review included patients with GO who underwent rehabilitative orbital decompression for disfiguring proptosis in an inactive state with a low clinical activity score (0-2) between January 2017 and December 2020 by a single surgeon. Exophthalmos was measured using a Hertel exophthalmometer, and recurrence was defined as an increase of 2 mm or more after decompression during the follow-up period. The association between preoperative variables and proptosis recurrence was analyzed using multivariable logistic regression. RESULTS Of the total 217 patients, 11 (5.1%) developed recurrence of proptosis during the follow-up period (range, 3-30; mean, 15.6 months). Univariate logistic regression analysis identified thyroid-stimulating hormone receptor antibody (TRAb) and thyroid-stimulating immunoglobulin (TSI) as significant factors for recurrence, with age, sex, smoking, disease duration, orbital radiotherapy, and total thyroidectomy history being nonsignificant. TRAb remained significant in a multivariate logistic regression analysis (odds ratio, 1.06; P = .014). Receiver operating characteristic curve analysis revealed an area under the curve of 0.86 with a sensitivity of 90.9% and specificity of 82.0% at a TRAb level of 7.96 IU/L. CONCLUSION Preoperative TRAb and TSI are valuable markers to predict proptosis recurrence after orbital decompression. These results may help surgeons to decide the optimal timing for orbital decompression to lessen the risk of postoperative recurrence of proptosis.
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Affiliation(s)
- Hyeong Ju Byeon
- From the Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (H.J.B., J.K., J.S.Y.)
| | - JaeSang Ko
- From the Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (H.J.B., J.K., J.S.Y.)
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego, San Diego, California, USA (D.O.K.)
| | - Jin Sook Yoon
- From the Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (H.J.B., J.K., J.S.Y.).
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Huelin FJ, Del Valle JMR, Sales-Sanz M, Ye-Zhu C, Díaz-Montealegre A, Muñoz-Negrete FJ. Postoperative drift and dose-response of strabismus surgery in thyroid eye disease: predicting desired outcomes with intraoperative adjustable sutures. Can J Ophthalmol 2024; 59:e53-e60. [PMID: 36402196 DOI: 10.1016/j.jcjo.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/06/2022] [Accepted: 10/22/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report outcomes of strabismus surgery in thyroid eye disease using intraoperative bow-knot adjustable sutures under topical anaesthesia and calculate prediction models for surgical correction and postoperative drift depending on surgical dose-response. METHODS We retrospectively reviewed patients operated on from 2016 to 2021. A satisfactory outcome was defined as no diplopia with maintenance of vertical (<5 PD) and horizontal (<10 PD) stable alignment at primary gaze. Subjective diplopia corrected with prisms within successful motor alignment was defined as a fair result. Otherwise, the result was considered to be poor. RESULTS A total of 73 patients were included (60 females, 82%). Mean preoperative horizontal and vertical deviations were 26.9 PD (19.1 SD), and 11.8 PD (7.6 SD), respectively. Mean horizontal drift was -3.2 PD (5.2 SD), whereas mean vertical drift was -3.4 PD (3.3 SD). A linear regression established a dose-response of 2.37 PD/mm for each medial rectus recession (p < 0.0001; r2 = 0.777) and 3.75 PD/mm for unilateral inferior rectus recession (p < 0.0001; r2 = 0.922). Final success rate was satisfactory in 62 patients (85%), fair in 7 patients (10%), and poor in 4 patients (5%). CONCLUSIONS Muscle recession with intraoperative adjustable sutures is effective for the treatment of thyroid eye disease strabismus. Predictable dose-responses could be achieved with a drift toward overcorrection. Undercorrection proportional to the planned surgical dose should be the immediate postoperative target of choice. Other variables such as orbital decompression and concurrent vertical and horizontal surgery do not correlate with dose-response and postoperative drift. However, further studies are necessary to validate our findings.
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Affiliation(s)
- Fernando J Huelin
- Ophthalmology Service, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - José María Rodriguez Del Valle
- Ophthalmology Service, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - Marco Sales-Sanz
- Ophthalmology Service, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Ophthalmology Department, IMO Madrid Grupo Miranza, Madrid, Spain
| | - Cristina Ye-Zhu
- Ophthalmology Service, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ana Díaz-Montealegre
- Ophthalmology Service, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francisco J Muñoz-Negrete
- Ophthalmology Service, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; School of Medicine, Universidad de Alcalá, Madrid, Spain
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14
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Grusha YO, Kochetkov PA, Sviridenko NY, Kolodina AS, Dzamikhov IK. [Bony orbital decompression in thyroid eye disease]. Vestn Oftalmol 2024; 140:103-108. [PMID: 38450474 DOI: 10.17116/oftalma2024140011103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
This article summarizes the results of research on the morphological and functional features of different types of orbital bone decompression in thyroid eye disease (TED) and presents an analysis of surgical anatomy of the lateral orbital wall in the context of performing deep lateral bone decompression of the orbit was carried out. The study includes an analysis of the results of orbital bone decompression with resection of the greater wing of the sphenoid bone using ultrasound osteodestructor in comparison with osteodestruction using a high-speed drill, description of transethmoidal orbital decompression with endonasal access both as a single method of surgical treatment of TED and in combination with lateral bone decompression of the orbit, including the advantages and disadvantages of the method, and presents a morphological description of the pathological changes in the medial orbital wall bone fragments obtained during endonasal transethmoidal orbital decompression in patients with TED.
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Affiliation(s)
- Y O Grusha
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - P A Kochetkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N Yu Sviridenko
- National Medical Research Center for Endocrinology, Moscow, Russia
| | - A S Kolodina
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - I K Dzamikhov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Lv X, Gao Y, Ma Y, Li C, Ren Y, Zhang Z, Bao Y, Su S, Lu R. Comparison of surgical effect in active and inactive Dysthyroid Optic Neuropathy after Endoscopic Transnasal Medial Orbital Decompression. Graefes Arch Clin Exp Ophthalmol 2024; 262:281-293. [PMID: 37530848 DOI: 10.1007/s00417-023-06187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To evaluate and compare the changes in orbital soft tissue volume and visual function after endoscopic transnasal medial orbital decompression in patients with active and inactive dysthyroid optic neuropathy (DON). METHODS This prospective, cohort study recruited 112 patients (112 eyes) with DON who were divided into an active and inactive DON group (56 eyes each) by clinical activity scores. All patients underwent endoscopic transnasal medial orbital decompression. The pre- and post-operative orbital soft tissue volumes were measured with high-resolution computed tomography (CT) using Mimics software. Visual function, including best-corrected visual acuity (BCVA), visual field (VF), and visual evoked potential (VEP), was recorded before and after surgery. RESULTS Preoperatively, compared with the inactive DON group, the active DON group had greater extraocular muscle volume (EMV) and EMV/orbital volume (OV) ratio, but worse BCVA, VF, and exophthalmos. Postoperatively, although the EMV slightly increased, with the enlarged medial rectus muscle contributing dramatically, the EMV/OV ratio decreased in patients with DON. Besides, visual function including BCVA, VF, VEP and exophthalmos was also improved in both groups after surgery. There were no significant differences in postoperative OV; EMV; EMV/OV ratio; and the BCVA, VF, and VEP parameters between both groups (all P > 0.05). CONCLUSION Patients with DON who did not respond well to steroids, regardless of disease activity, may benefit from orbital decompression via the decrease in the proportion of EMV in OV, especially patients with active DON, who showed more improved visual function than patients with inactive DON.
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Affiliation(s)
- Xi Lv
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yang Gao
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yujun Ma
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Cheng Li
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yi Ren
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Zhihui Zhang
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yuekun Bao
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Shicai Su
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Rong Lu
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
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Hou X, Tu Y, Min X, Du K, Li F, Wang J, Wu X. The effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid ophthalmopathy. J Fr Ophtalmol 2024; 47:103924. [PMID: 37775455 DOI: 10.1016/j.jfo.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To evaluate the effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy. METHODS This retrospective study enrolled 55 eyes of 33 patients treated in our hospital for restrictive strabismus caused by thyroid-associated ophthalmopathy. We performed muscle recession for the obviously restricted extraocular muscles, with 6 weeks of follow-up. Surgical outcomes were compared between the orbital decompression group (DG, n=15) and non-orbital decompression group (NDG, n=18). RESULTS A total of 33 patients with Graves' ophthalmopathy who underwent rectus muscle recession surgery were included. Of these, 15 patients had undergone orbital decompression prior to strabismus surgery, and 18 had not. The two groups did not differ in terms of the preoperative horizontal or vertical ocular deviation, degree of restriction of eye movement, degree of diplopia, or mean number of muscles that underwent surgery (P>0.05). There was no significant difference in the preoperative horizontal or vertical ocular deviation, level of eye movement restriction, degree of diplopia and the success rate of the surgery (P>0.05). CONCLUSION Rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy during the quiescent period could improve the ocular deviation and diplopia, and orbital decompression performed before strabismus surgery had no significant effect on surgical technique or outcomes of rectus muscle recession surgery.
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Affiliation(s)
- X Hou
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - Y Tu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - X Min
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - K Du
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - F Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - J Wang
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China.
| | - X Wu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China.
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Li C, Gao Y, Zhang Z, Lv X, Bao Y, Ma Y, Chen R, Cheng C, Li J, Liu Y, Jin L, Luo G, Shi J, Lu R. Surgical Outcomes of Standardized Endoscopical Deep Medial Orbital Decompression in Dysthyroid Optic Neuropathy. Ophthalmic Res 2023; 67:39-50. [PMID: 38109861 DOI: 10.1159/000535330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION The aim of the study was to standardize the endoscopic deep medial orbital decompression surgery for better relief of optic nerve compression in dysthyroid optic neuropathy (DON). METHODS A total of 128 eyes from patients received the standardized endoscopic deep medial orbital decompression surgery were recruited in this study. The efficacy of the procedure was assessed at a 1-month follow-up by the best-corrected visual acuity (VA), visual field (VF), and visual evoked potential (VEP). Clinical data were collected to explore the factors that affected visual recovery. Oxygen saturation of retinal blood vessels, retinal thickness, and vessel density were measured to demonstrate the potential recovery mechanisms. RESULTS After surgery, the ratio of extraocular muscle volume in the orbital apex to orbital apex volume significantly decreased from 44.32 ± 22.31% to 36.82 ± 12.02% (p < 0.001). 96.87% of eyes' final VA improved; average VA improved from 0.93 ± 0.73 to 0.50 ± 0.60 at 1 week (p < 0.001) and 0.40 ± 0.53 at 1 month (p < 0.001). Postoperatively, VF and VEP also improved, the oxygen saturation of retinal arteries increased, and the retinal thickness was reduced. Preoperative VA, visual impairment duration, and clinical activity score evaluation were associated with visual recovery. CONCLUSION In this study, we standardized the endoscopic deep medial orbital decompression, of which key point was to relieve pressure in the orbital apex and achieved satisfactory visual recovery in DON patients.
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Affiliation(s)
- Cheng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China,
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China,
| | - Yang Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhihui Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xi Lv
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuekun Bao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yujun Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Chao Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jinmiao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yaoming Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Guangwei Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rong Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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18
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Jamshidian Tehrani M, Niktinat H, Ebrahimiadib N, Jafari B, Rafizadeh SM, Kasaee A. Assessment of retinal and choroidal vessel density and nerve fibre layer thickness changes after orbitotomy in patients with severe non-active thyroid orbitopathy: a prospective study. Int Ophthalmol 2023; 43:4427-4433. [PMID: 37878198 DOI: 10.1007/s10792-023-02790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 06/22/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE To evaluate the optical coherence tomography angiogram changes in non-active severe thyroid-related ophthalmopathy patients after cosmetic bone decompression. METHODS Eighteen patients (25 eyes) with severe not active not compressive (NANC) TED who were candidates for decompression surgery for cosmetic reasons were included in this study, and a 3 × 3 mm macular scan was used to measure vessel density and RNFL thickness. Whole macular vessel density in its superficial, deep and choriocapillaris layers was evaluated. The following data were extracted for each of layers: superior and inferior hemispheres, fovea, parafoveal vessel density, its superior and inferior hemispheres, and temporal, superior, nasal and inferior quadrant. RESULTS The mean RPC increased postoperatively, which was statistically significant in small vessels of peripapillary area (p-value = 0.045). The mean RNFL thickness decreased after surgery and it was statistically significant in the peripapillary (p-value = 0.032) and Inferior-Hemifield area (p-value = 0.036). The choriocapillaris changes were significant in Superior-Hemifield (p-value = 0.031) and Fovea (p-value = 0.03). CONCLUSION Thyroid-associated orbitopathy patients have a tendency to decrease vascular density and correlated with disease activity more than stage of orbitopathy. There was not a strong and even discrepant result in linkage of RNFL thickness and other optic nerve function tests and TED patient status and it is needed to do studies with more epidemiologic power and same methodology of study to be more comparable.
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Affiliation(s)
- Mansoreh Jamshidian Tehrani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Hanieh Niktinat
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | | | - Behzad Jafari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Abolfazl Kasaee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.
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19
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Naik MN, Walvekar P, Vasanthapuram VH, Shankar L. Eyelid Surgery in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2023; 39:S92-S104. [PMID: 38054989 DOI: 10.1097/iop.0000000000002543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE To review and summarize a comprehensive synopsis of surgery of the eyelid in thyroid eye disease (TED). METHODS A PubMed search for specific eyelid manifestations of TED was performed. Studies reporting surgical management of these were reviewed, along with the author's own experience. RESULTS The most common eyelid manifestations of TED include eyelid retraction, blepharoptosis, entropion, and epiblepharon, with most of them requiring surgical intervention. The correction of eyelid retraction has received maximum attention, with several surgical techniques that have stood the test of time. Blepharoptosis in TED that requires surgical intervention is usually aponeurotic. Entropion and Epiblepharon are rare in TED, and may resolve spontaneously, or following orbital decompression. CONCLUSIONS Retraction is the commonest eyelid manifestation of TED, with multiple surgical options available for its correction. Blepharoptosis, entropion, and epiblepharon are rare eyelid findings in TED, that may occasionally require surgical correction.
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Affiliation(s)
- Milind N Naik
- Hariram Motumal Nasta, and Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
| | - Priyanka Walvekar
- Ophthalmic Plastic Surgery Service, Narayana Nethralaya, Bangalore, India
| | | | - Lekshmy Shankar
- Hariram Motumal Nasta, and Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
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20
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Goel R, Shah S, Gupta S, Khullar T, Singh S, Chhabra M, Khanam S, Kumar S, Sharma P. Alterations in retrobulbar haemodynamics in thyroid eye disease. Eye (Lond) 2023; 37:3682-3690. [PMID: 37221361 PMCID: PMC10686394 DOI: 10.1038/s41433-023-02580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE To study the orbital perfusion parameters of ophthalmic artery (OA) and central retinal artery (CRA) in inactive TED and the changes following surgical decompression. METHODS Non-randomised clinical trial. 24 inactive moderate-to-severe TED orbits of 24 euthyroid cases underwent surgical decompression and examined again at 3 months. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) of OA and CRA were evaluated using colour doppler imaging and normative database was established using 18 healthy controls. RESULTS The mean age was 39.38 ± 12.56 years and male: female ratio was 1: 1.18. Intraocular pressure was higher, and CRA-PSV, CRA-RI, OA-PSV, and OA-EDV were lower in TED in comparison to heathy orbits. The CRA-PSV, CRA-EDV, OA-PSV, and OA-EDV negatively correlated with proptosis and duration of thyroid disease. The area under curve of OA-PSV (95% CI:0.964-1.000, p < 0.001) and OA-EDV (95% CI:0.699-0.905, p < 0.001) helped in differentiating TED orbits from HC, and in predicting the severity of disease. Post decompression, CRA-PSV, CRA-EDV, OA-PSV, and OA-EDV improved, with decrease in CRA-RI and OA-RI in both lipogenic and MO. CONCLUSIONS The orbital perfusion is reduced in inactive TED. The changes in OA flow velocities can help in differentiating inactive TED from healthy orbits and progression of TED. Sequential orbital CDI of OA and CRA can serve as an objective tool for case selection and monitoring response to surgical decompression.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India.
| | - Swati Gupta
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Tamanna Khullar
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Sonam Singh
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Mohit Chhabra
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Samreen Khanam
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Sumit Kumar
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Pankaj Sharma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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21
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Ghiam S, Wang Y, Rootman DB. Re: "Lateral Rectus Muscle Expands More Than Medial Rectus Following Maximal Deep Balanced Orbital Decompression". Ophthalmic Plast Reconstr Surg 2023; 39:649. [PMID: 37922048 DOI: 10.1097/iop.0000000000002538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
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22
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Jeffers JV, Akella SS, Tran AQ, Setabutr P. Cocaine Orbitopathy Complicated by Orbital Wall Defects, Bilateral Naso-Orbital Fistulas, Phthisis, and Bilateral Vision Loss. Ophthalmic Plast Reconstr Surg 2023; 39:e211. [PMID: 36928035 DOI: 10.1097/iop.0000000000002372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Johnathan V Jeffers
- Department of Ophthalmology, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, Illinois, U.S.A
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23
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Caetano FB, Garcia DM, Abbud CMM, Cruz AAV. The effect of rim-off deep lateral orbital decompression on the lateral rectus shape and oculomotor balance. Int Ophthalmol 2023; 43:4315-4321. [PMID: 37561253 DOI: 10.1007/s10792-023-02843-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE The purpose of the study was to measure the effect of rim-off deep lateral decompression for Graves orbitopathy on the lateral rectus muscle path and oculomotor balance. METHODS Retrospective analysis of the medical records and pre- and postoperative computed tomography scans of 34 orbits of 23 patients who underwent deep lateral decompression alone. The oculomotor balance of these 23 patients was measured with the alternate cover test and prisms before and after surgery. Bezier functions were used to measure the postoperative path of the lateral rectus in all decompressed orbits. RESULTS Deep lateral decompression induced a curvilinear deformation of the lateral rectus. There was no significant correlation between the position of the point of maximum muscle displacement and the size of the residual lateral wall. The changes in the lateral rectus path had no adverse effects on the oculomotor balance of the patients. CONCLUSIONS The location of the curvilinear deformation of the lateral rectus does not depend on the residual segment of the lateral wall. The changes of the lateral rectus path have no deleterious effect on the oculomotor balance.
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Affiliation(s)
- Fabiana B Caetano
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Denny M Garcia
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Christine M M Abbud
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio A V Cruz
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
- Departamento de Oftalmologia, Hospital das Clínicas-Campus, Ribeirão Preto, São Paulo, 14049-900, Brazil.
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24
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Ghiam BK, Liu BJ, Echegaray JJ, Prendes MA. External Compressive Ischemic Orbitopathy: A Rising Clinical Entity. Ophthalmic Plast Reconstr Surg 2023; 39:548-557. [PMID: 37486344 DOI: 10.1097/iop.0000000000002430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE Saturday night retinopathy, the term coined by Jayam et al . in 1974, is a rare condition in which external compression of the orbit during a drug and alcohol stupor causes a unilateral orbitopathy with ophthalmoplegia and ischemic retinopathy. This condition has been increasingly reported in the last decade, correlating with an increasing burden of substance use. This condition mirrors a similar entity typically reported in patients following spinal surgery, where a headrest supporting the patient's face compresses the orbit. The current authors combine these 2 entities, entitled external compressive ischemic orbitopathy, and present a comprehensive literature review describing this entity. METHODS A systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All related publications of vision loss in the setting of orbital compression were reviewed. Data collected included patient demographics, precipitating circumstances of vision loss, presenting ocular symptoms, outcomes, and ancillary imaging. RESULTS In total 31 articles were selected for inclusion, yielding 46 patients. A total of 10 patients suffered orbitopathy in the setting of a drug stupor, and 36 following prone-positioned surgery. However, 79% of patients presented with visual acuity of light perception or worse. Also, 86% of patients presented with ophthalmoplegia, 92% with proptosis and orbital edema, and 86% with varying degrees of retinal ischemia. When compared with iatrogenic cases, self-induced stuporous cases demonstrated worse presenting visual acuity, ophthalmoplegia, retinal and choroidal filling, and worse final outcomes. CONCLUSION External compressive ischemic orbitopathy is a severe vision-threatening condition that has been increasingly reported in the last decade.
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Affiliation(s)
- Benjamin K Ghiam
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Brian J Liu
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, U.S.A
| | - Jose J Echegaray
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Mark A Prendes
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio, U.S.A
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25
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Anees A, Ayeni FE, Eslick GD, Edirimanne S. TSH receptor autoantibody levels post-total thyroidectomy in Graves' ophthalmopathy: a meta-analysis. Langenbecks Arch Surg 2023; 408:415. [PMID: 37870639 PMCID: PMC10593610 DOI: 10.1007/s00423-023-03153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND TSH receptor autoantibodies (TRAbs) are pathognomonic for Graves' disease and are thought to also underly the pathogenesis of Graves' ophthalmopathy (GO). A decline in TRAb levels has been documented post-total thyroidectomy (TTx) in GO, however with conflicting correlations with disease outcomes. The aim of the study was to compare the effectiveness of TTx to other treatment modalities of Graves' disease and examine whether the lowering of TRAbs is associated with GO improvements. METHOD We searched electronic databases including Medline, Embase, Scopus, and Web of Science until 31 September 2022 using a broad range of keywords. Patients with GO undergoing TTx with measurements of both TRAbs and progression of the disease using a validated GO scoring system were included. Fourteen studies encompassing data from 1047 patients with GO met our eligibility criteria. The PRISMA guidelines were followed, and five studies had comparable data that were suitable for a meta-analysis. RESULTS The Cochrane Risk of Bias tool for RCTs showed low risk of bias across most domains. The pooled odds ratio showed that more patients significantly had normalized TRAb levels post-TTx as compared to other interventions (OR: 1.36, 95% CI: 1.02-1.81, p = 0.035). But, there was no significant difference in GO improvement post-TTx as compared with other intervention groups. CONCLUSIONS This meta-analysis shows that TRAb levels may decline largely post-TTx, but may not predict added improvements to the progression of GO. Thus, future studies with uniform designs are required to assess the minimal significant GO improvements.
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Affiliation(s)
- Arsalan Anees
- Department of Surgery, Nepean Hospital, Penrith, 2750, Australia
| | - Femi E Ayeni
- Department of Surgery, Nepean Hospital, Penrith, 2750, Australia.
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby St, Penrith, NSW, 2750, Australia.
| | - Guy D Eslick
- Sydney Medical School, The University of Sydney, Sydney, Australia
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26
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Equitério BSN, Caetano F, Kozorosky HA, Cruz AAVE. Apical bleeding: a rare cause of blindness after orbital decompression. Arq Bras Oftalmol 2023; 87:e20220006. [PMID: 37851738 DOI: 10.5935/0004-2749.2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 09/07/2022] [Indexed: 04/03/2023] Open
Abstract
Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.
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Affiliation(s)
- Bruna Sâmara Nogueira Equitério
- Departamento de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabiana Caetano
- Departamento de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Hercules Antonio Kozorosky
- Departamento de Radiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Antonio Augusto Velasco E Cruz
- Departamento de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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27
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Pramono LA. Success Treatment of Severe and Active Graves' Orbitopathy with Tocilizumab After Thyroidectomy and Maximum Dose of Intravenous Methylprednisolone. Acta Med Indones 2023; 55:475-477. [PMID: 38213047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
We report a woman, 45th year old with Graves' disease treated with anti-thyroid drug (thiamazole). She came to our clinic with severe and active Graves' orbitopathy. We treated her with high dose intravenous methylprednisolone weekly (0.5 g weekly/ 6 weeks) and mycophenolate sodium 0.72 g daily/ 6 weeks. Because of her longterm consumption but not successful to achieve remission of anti-thyroid drugs and the size of her goiter, we decided to do total thyroidectomy. Only one week after thyroidectomy, her eye inflammation grade was reduced, but still bulging. We continue with the intravenous methylprednisolone weekly. Because of the partial response, we continue with another dose of methylprednisolone (0.25 g weekly for another 6 weeks).After 12 weeks of intravenous methylprednisolone (maximum dose for 1st course 4.5 g), there is a partial response make it to moderate to severe grade but still active inflammation. Our team decided to give her second-line treatment and we give her intravenous tocilizumab monthly for 4 weeks. After three tocilizumab infusion, the inflammation is reduced remarkably. Her overall appearance is getting better. But, because of her sight was not improved much as the inflammation reduced, we done orbital MRI and we decided to do another intravenous methylprednisolone 1 g for three days followed by orbital decompresion surgery. Shortly after the orbital decompresion, her sight was improved very well. She can now doing activities she can do previously. After recovery, we plan to give her the fourth (last) tocilizumab infusion. Overall, tocilizumab improves clinical outcome in patient with active corticosteroid-resistant moderate to severe Graves' orbitopathy. Patient's quality of life also improved.
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Affiliation(s)
- Laurentius Aswin Pramono
- 1. Department of Public Health and Nutrition, School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia - Department of Internal Medicine St Carolus Hospital, Jakarta, Indonesia. 2. Thyroid Eye Center, Jakarta Eye Center Menteng, Jakarta, Indonesia..
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28
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Armache M, McKnight T, Parsel SM, Chitguppi C, Toskala E, Rosen M, Watson A, Pribitkin E, Rabinowitz M, Rabinowitz M, Bilyk J, Nyquist G. Postoperative diplopia after medial-inferior orbital wall decompression in patients with thyroid eye disease. Int Forum Allergy Rhinol 2023; 13:1994-1996. [PMID: 37078590 DOI: 10.1002/alr.23170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/21/2023]
Abstract
KEY POINTS 10% of patients undergoing MAI decompression for TED developed new-onset diplopia MAI decompression remains an excellent option for orbital decompression for TED.
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Affiliation(s)
- Maria Armache
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tory McKnight
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sean M Parsel
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chandala Chitguppi
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Elina Toskala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Cherry Hill, New Jersey, USA
| | - Marc Rosen
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alison Watson
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Edmund Pribitkin
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Rabinowitz
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Mindy Rabinowitz
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jurij Bilyk
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Gurston Nyquist
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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29
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Taylor P, Rajendram R, Hanna S, Wilson V, Pell J, Li C, Cook A, Gattamaneni R, Plowman N, Jackson S, Hills R, French R, Uddin JM, Lee RWJ, Dayan CM. Factors Predicting Long-term Outcome and the Need for Surgery in Graves Orbitopathy: Extended Follow-up From the CIRTED Trial. J Clin Endocrinol Metab 2023; 108:2615-2625. [PMID: 36971324 PMCID: PMC10505546 DOI: 10.1210/clinem/dgad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/28/2023]
Abstract
Graves orbitopathy is both disabling and disfiguring. Medical therapies to reduce inflammation are widely used, but there is limited trial data beyond 18 months of follow-up. METHODS Three-year follow-up of a subset of the CIRTED trial (N = 68), which randomized patients to receive high-dose oral steroid with azathioprine/placebo and radiotherapy/sham radiotherapy. RESULTS Data were available at 3 years from 68 of 126 randomized subjects (54%). No additional benefit was seen at 3 years for patients randomized to azathioprine or radiotherapy with regard to a binary clinical composite outcome measure (BCCOM), modified European Group on Graves' Orbitopathy score, or Ophthalmopathy Index.Clinical Activity Score (CAS), Ophthalmopathy Index, and Total Eye Score improved over 3 years (P < .001). However, quality of life at 3 years remained poor. Of 64 individuals with available surgical outcome data, 24 of 64 (37.5%) required surgical intervention. Disease duration of greater than 6 months before treatment was associated with increased need for surgery [odds ratio (OR) 16.8; 95% CI 2.95, 95.0; P = .001]. Higher baseline levels of CAS, Ophthalmopathy Index, and Total Eye Score but not early improvement in CAS were associated with increased requirement for surgery. CONCLUSION In this long-term follow-up from a clinical trial, 3-year outcomes remained suboptimal with ongoing poor quality of life and high numbers requiring surgery. Importantly, reduction in CAS in the first year, a commonly used surrogate outcome measure, was not associated with improved long-term outcomes.
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Affiliation(s)
- Peter Taylor
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - Rathie Rajendram
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | - Stephanie Hanna
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | | | - Julie Pell
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - Chunhei Li
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - Anne Cook
- Manchester Royal Eye Hospital, Manchester, M13 9WH, UK
| | | | | | - Sue Jackson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 2JP, UK
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Robert French
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - Jimmy M Uddin
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | - Richard W J Lee
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- Bristol Medical School, University of Bristol, UK
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London EC1V 9EL, UK
| | - Colin M Dayan
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
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Wang M, Jiang X, Geng J, Hui S, Li D. Outcomes of Patients With Dysthyroid Optic Neuropathy Treated With Intravenous Corticosteroids and/or Orbital Decompression Surgery: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2023; 108:2717-2727. [PMID: 37066814 DOI: 10.1210/clinem/dgad211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 04/18/2023]
Abstract
CONTEXT The level of evidence is low for the treatment of patients with dysthyroid optic neuropathy (DON) and there is no consensus on the treatment of DON with intravenous high-dose glucocorticoids (ivGC) or direct surgical decompression. OBJECTIVE To compare the efficacy of glucocorticoid treatment and orbital decompression (OD) in DON. DATA SOURCES PubMed, EMBASE, and Cochrane Library were searched along with other sources. STUDY SELECTION A total of 17 studies met the inclusion criteria. DATA EXTRACTION Standard methodological guidance of the Cochrane Handbook was used and data were independently extracted by multiple observers. The primary outcomes were the improvement of best corrected visual acuity (ΔBCVA). Secondary outcomes were proptosis reduction, change in diplopia, visual field defects, and intraocular pressure (IOP). DATA SYNTHESIS The ΔBCVA in the ivGC + OD group was improved 0.26 LogMAR more than in the ivGC group (P = .007). The ΔBCVA in the OD group was better than in the ivGC group (P = .008). Posttreatment proptosis in the ivGC + OD and OD groups were improved further by 3.54 mm and 3.00 mm, respectively, than in the ivGC group (P < .01). The mean deviation (MD) in the ivGC + OD group was improved by an additional 5.33 dB than in the ivGC group (P = .002). The IOP in the ivGC + OD group was improved further than in the ivGC group (P = .03). CONCLUSIONS Based on the results of the present meta-analysis, OD or ivGC + OD may be more effective in improving BCVA and MD and reducing proptosis compared with ivGC. Compared with ivGC alone, ivGC + OD is more effective in improving IOP than ivGC. Although this study improves the hierarchy of evidence in the treatment of DON, additional randomized controlled trials are needed to confirm this conclusion.
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Affiliation(s)
- Mingyang Wang
- Beijing Tongren Eye Center, and Beijing Ophthalmology Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xue Jiang
- Beijing Tongren Eye Center, and Beijing Ophthalmology Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jialu Geng
- Beijing Tongren Eye Center, and Beijing Ophthalmology Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Shiqi Hui
- Beijing Tongren Eye Center, and Beijing Ophthalmology Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Dongmei Li
- Beijing Tongren Eye Center, and Beijing Ophthalmology Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Huang Y, Li K, Yan Y, He J, Chen J. Strabismus surgery for improving the quality of life of strabismus patients with thyroid-associated ophthalmopathy. Medicine (Baltimore) 2023; 102:e34778. [PMID: 37657062 PMCID: PMC10476816 DOI: 10.1097/md.0000000000034778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023] Open
Abstract
Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease involving the ocular tissues that may require strabismus surgery treatment. Presently, little is known about the impact of strabismus surgery on the quality of life of such patients. Consequently, the aim of the present study was to explore the effect of strabismus surgery on the quality of life of strabismus patients with quiescent TAO. This was a prospective case-series study. Strabismus patients with TAO who were admitted to the First Affiliated Hospital of Guangxi Medical University for strabismus surgery from October 2011 to April 2016 were included in this study. The included patients were asked to complete the Graves' ophthalmopathy quality of life questionnaire (GO-QOL) before strabismus surgery and 6 weeks after the surgery, respectively. Preoperative and postoperative GO-QOL scores were compared using the paired samples t-test. The correlation between strabismus surgery and the quality of life was analyzed using Spearman correlation analysis. In total, 23 patients, with a mean age of 49.04 years old, were included in the study. Compared to the preoperative GO-QOL scores, the postoperative scores of these patients for visual function (43.04 vs 73.50, P < .001) and psychosocial function (40.13 vs 72.93, P < .001) were both significantly increased. The greater the preoperative angle of misalignment of the eyes, the worse the psychosocial function (r = -0.433, P = .039). Strabismus surgery can significantly improve the quality of life of strabismus patients with quiescent TAO.
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Affiliation(s)
- Yihua Huang
- Department of Ophthalmology, Wuming School of Clinical Medicine of Guangxi Medical University, Wuming Hospital of Guangxi Medical University, Nanning, China
| | - Kaijun Li
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuqing Yan
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianfeng He
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinmao Chen
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Du R, Wang F, Yang C, Hu J, Liu J, Jian Q, Wang R, Zhang J, Chen H, Wang Y, Zhang F. Metabolic features of orbital adipose tissue in patients with thyroid eye disease. Front Endocrinol (Lausanne) 2023; 14:1151757. [PMID: 37600696 PMCID: PMC10435847 DOI: 10.3389/fendo.2023.1151757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
Background Thyroid eye disease (TED) is the most frequent orbital disease in adults and is characterized by the accumulation of orbital adipose tissue (OAT). It can lead to eyelid retraction or even vision loss. Orbital decompression surgery serves as the primary treatment for inactive TED by removing the excess OAT. However, there is a lack of alternative treatments to surgery due to the unclear understanding of the pathogenesis, particularly the metabolic features. Accordingly, our study was implemented to explore the content and features of metabolites of OATs from TED patients. Method The OATs used in the current study were obtained from the orbital decompression surgery of seven patients with inactive TED. We also collected control OATs from eye surgical samples of five individuals with no history of autoimmune thyroid diseases, TED, or under non-inflammatory conditions. The liquid chromatography mass spectrometer was used for the measurements of the targeted metabolites. Afterwards, we performed differential metabolite assay analysis and related pathway enrichment analysis. Results In our study, a total of 149 metabolite profiles were detected in all participants. There were significant differences in several metabolite profiles between the TED group and the control group, mainly including uric acid, oxidized glutathione, taurine, dGMP, oxidized glutathione 2, uracil, hexose-phosphate, 1-methylnicotinamide, D-sedoheptulose 1,7-bisphosphate, and uridine 5'-monophosphate (all p-value < 0.05). The TED-related pathways identified included purine metabolism, beta-alanine metabolism, glutathione metabolism (p-values < 0.05). Our study found overlaps and differences including uric acid and uracil, which are in accordance with metabolites found in blood of patients with TED from previous study and several newly discovered metabolite by our study such as hexose-phosphate, 1-methylnicotinamide, D-sedoheptulose 1,7-bisphosphate, compared to those tested from blood, OAT, or urine samples reported in previous studies. Conclusion The findings of our study shed light on the metabolic features of OAT in individuals with TED. These results may help identify new treatment targets for TED, providing potential avenues for developing alternative treatments beyond ophthalmic surgery.
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Affiliation(s)
- Rui Du
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenfen Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Yang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Hu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiapei Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qizhi Jian
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruonan Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Guo J, Ma R, Gan L, Li X, Xue K, Cheng J, Qian J. Changes in retinal nerve fibre layer, ganglion cell layer and visual function in eyes with thyroid eye disease of different severities with and without orbital decompression. Eye (Lond) 2023; 37:1571-1576. [PMID: 35902746 PMCID: PMC10219964 DOI: 10.1038/s41433-022-02142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/15/2022] [Accepted: 06/10/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate progressive changes in retinal nerve fibre layer (RNFL), ganglion cell layer/inner plexiform layer (GCL/IPL) and visual function in thyroid eye disease (TED) patients with and without orbital decompression. METHODS Sixty TED patients (105 eyes) were included. All patients were divided into mild, moderate-to-severe and dysthyroid optic neuropathy (DON) groups. Orbital decompression was performed in the moderate-to-severe and DON groups. Optic coherence tomography (OCT), visual field (VF) and best-corrected visual acuity (BCVA) were performed pre- and postoperatively. Preoperative follow-up was performed in the mild group and in part of the moderate-to-severe and DON groups. RESULTS After decompression, the thickness of GCL/IPL and RNFL significantly decreased in DON group (p < 0.05), with varying degrees of decrease in eyes with optic disc swelling, atrophy and normal appearance. The mean GCL/IPL thickness significantly decreased in moderate-to-severe group (p < 0.05), the mean RNFL thickness slightly decreased with no statistical significance (p = 0.07). During the preoperative follow-ups, the mean GCL/IPL thickness significantly decreased (p = 0.04), whereas the mean RNFL thickness tended to increase (p = 0.13) in DON group. The thickness of GCL/IPL and RNFL did not change significantly in the mild and moderate-to-severe groups (p > 0.05). BCVA and VF did not change significantly in any group (p > 0.05) preoperatively. CONCLUSION Swelling and degeneration of retinal ganglion cells (RGCs) may coexist in DON eyes, leading to continuous changes in the RNFL and GCL/IPL thickness either before or after decompression. Slight swelling and degeneration of RGCs may exist in moderate-to-severe TED eyes, although OCT measurements and visual functions remain stable before surgery.
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Affiliation(s)
- Jie Guo
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ruiqi Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Lu Gan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaofeng Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Kang Xue
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jinwei Cheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jiang Qian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Oke I, Reshef ER, Elze T, Miller JW, Lorch AC, Hunter DG, Freitag SK. Smoking Is Associated With a Higher Risk of Surgical Intervention for Thyroid Eye Disease in the IRIS Registry. Am J Ophthalmol 2023; 249:174-182. [PMID: 36690290 PMCID: PMC10767645 DOI: 10.1016/j.ajo.2023.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe the association of smoking status with surgical intervention for thyroid eye disease (TED) at the population-level. DESIGN Retrospective cohort study. METHODS This study included all adults (aged ≥18 years) with Graves disease in the Intelligent Research in Sight (IRIS) Registry (January 1, 2013, to December 31, 2020). The primary outcome was surgical intervention for TED, stratified into orbital decompression, strabismus surgery, and eyelid recession surgery. The Kaplan-Meier estimated 5-year cumulative probability for each surgical intervention was calculated. Multivariable Cox regression was used to evaluate the association between smoking status and each surgical intervention, adjusting for age, sex, race, ethnicity, and geographic region. RESULTS This study included 87,774 patients. Median age was 59 years (IQR, 48-68 years); 81% were female patients. Current smokers had a greater 5-year cumulative probability of orbital decompression (3.7% vs 1.9%; P < .001), strabismus surgery (4.6% vs 2.2%; P < .001), and eyelid recession (4.1% vs 2.6%; P < .001) compared to never smokers. After adjusting for demographic factors, current smokers were at greater risk for orbital decompression (hazard ratio [HR], 2.1; 95% CI, 1.8-2.4; P < .001), strabismus surgery (HR, 2.0; 95% CI, 1.8-2.3; P < .001), and eyelid recession (HR, 1.7; 95% CI, 1.5-1.9; P < .001) than never smokers. Former smokers were at higher risk for each type of surgery for TED, albeit at lower levels than current smokers. CONCLUSIONS Smoking was associated with increased risk of surgical intervention for TED in the IRIS Registry. Former smokers were at a lower risk than current smokers, supporting the role of smoking cessation on lowering the burden of surgical disease at the population-level.
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Affiliation(s)
- Isdin Oke
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
| | - Edith R Reshef
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Elze
- Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Joan W Miller
- Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice C Lorch
- Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - David G Hunter
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne K Freitag
- From the Department of Ophthalmology (I.O., E.R.R., D.G.H., S.K.F.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (I.O., E.R.R., T.E., J.W.M., A.C.L., D.G.H., S.K.F.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Gupta A, Garcia MD, North V, Kazim M, Rose GE. Residual Apical Lamina Papyracea as a Cause for Persistent Dysthyroid Optic Neuropathy After Orbital Decompression. Ophthalmic Plast Reconstr Surg 2023; 39:e37-e40. [PMID: 36190789 DOI: 10.1097/iop.0000000000002290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Two patients had persistent compressive dysthyroid optic neuropathy after decompression of the medial orbital wall and floor. In both cases, there was ~3 mm of unresected lamina papyracea anterior to the Annulus of Zinn, and removal of this residual bone led to resolution of the neuropathy. These illustrative cases suggest that, in some patients, even small amounts of residual crowding at the orbital apex can critically embarrass optic nerve perfusion, with resulting continued ischemic optic neuropathy.
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Affiliation(s)
- Ankur Gupta
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Maria D Garcia
- Division of Oculoplastics and Orbital Surgery, Edward S Harkness Eye Institute, Columbia University, New York, New York, U.S.A
| | - Victoria North
- Division of Oculoplastics and Orbital Surgery, Edward S Harkness Eye Institute, Columbia University, New York, New York, U.S.A
| | - Michael Kazim
- Division of Oculoplastics and Orbital Surgery, Edward S Harkness Eye Institute, Columbia University, New York, New York, U.S.A
| | - Geoffrey E Rose
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
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Abstract
Graves' orbitopathy (GO) is a complex autoimmune disorder of the orbit that causes the eye to appear disfigured. GO is typically associated with Graves' disease, an inflammatory autoimmune condition that is caused by thyrotropin receptor autoantibodies. Although our knowledge of the pathophysiology of GO has improved, its exact pathogenesis remains unclear. Some patients suffer from disfigurement, double vision, and even vision loss rather than hyperthyroidism. The disease severity and activity prompt different treatments, as the signs of GO are heterogeneous, so their management can be very complex. Despite medical advances, the first-line treatment for moderate-to-severe active GO is still glucocorticoids, while surgery can be critical for the treatment of chronic inactive GO. Surgery is sometimes required in the acute phase of the disease when there is an immediate risk to vision, such as in dysthyroid optic neuropathy. Most surgeries for GO are rehabilitative and subdivided into three categories: decompression, strabismus repair, and lid surgery. This review is a basic overview of the field, with up-to-date knowledge of the surgical techniques for GO. We review and summarize recent literature on the advances in surgery for GO to provide up-to-date insights on the optimal surgical treatment for GO.
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Affiliation(s)
- Joonyoung Baeg
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Han Sol Choi
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Charm Kim
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
- Department of Ophthalmology, AIN Woman`s Hospital, Incheon, Republic of Korea
| | - Hyuna Kim
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Jang
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Oeverhaus M, Koenen J, Bechrakis N, Stöhr M, Herrmann K, Fendler WP, Eckstein A, Weber M. Radioiodine ablation of thyroid remnants in patients with Graves’ orbitopathy. J Nucl Med 2022; 64:561-566. [PMID: 36418167 DOI: 10.2967/jnumed.122.264660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 11/25/2022] Open
Abstract
Our purpose was to assess response after ablation of thyroid remnants (ATR) with radioactive iodine therapy in patients with unstable Graves' orbitopathy (GO) after subtotal thyroidectomy. Methods: Thirty patients with mild (n = 4, 13%), moderate-to-severe (n = 25, 83%), or very severe GO (n = 1, 3%) were analyzed in this retrospective study. The primary endpoint was the improvement of GO-related symptoms as assessed by clinical activity scores, NOSPECS, and soft-tissue inflammation scores at 3 and 12 mo after ATR. Ablation success was defined by a decrease in 99mTc uptake on thyroid scintigraphy, remnant volume, and thyrotropin receptor antibody levels at 3 mo after ATR. Results: Twelve months after ATR, clinical activity scores, NOSPECS, and soft-tissue inflammation scores showed a significant decrease from 3.4 to 1.3 (P < 0.0001), 5.9 to 4.9 (P = 0.007), and 4.7 to 2.1 (P = 0.0001), respectively. The GO was inactive in 27 of the 30 (90%) patients after 3 mo and in 29 (97%) after 12 mo. No new activation of GO occurred. Remnant volume (1.4 vs. 0.4 cm3, P = <0.0001), mean thyrotropin receptor antibody level titer (19.02 vs. 13.37 IU/L, P < 0.0001), and 99mTc uptake (0.5% vs. 0.1%; n = 12; P = 0.04) decreased significantly until 3 mo after ATR. Discussion: Radioactive iodine therapy after thyroidectomy can successfully ablate residual thyroid remnants, leading to an improvement in GO, a reduction in inflammatory activity, and stabilization of thyroid function. Thus, scintigraphy should be considered for patients with unstable GO after thyroidectomy to rule out thyroid remnants.
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Affiliation(s)
- Michael Oeverhaus
- Department of Ophthalmology, University Hospital Essen, Essen, Germany; and
| | - Jana Koenen
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Nikolaos Bechrakis
- Department of Ophthalmology, University Hospital Essen, Essen, Germany; and
| | - Mareile Stöhr
- Department of Ophthalmology, University Hospital Essen, Essen, Germany; and
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Essen, Germany; and
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
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Nair AA, Ediriwickrema LS, Dolman PJ, Law G, Harrison AR, Mokhtarzadeh A, Stewart K, Men C, Lucarelli MJ, van Landingham S, Wingelaar M, Verma R, Chen A, Selva D, Garrity J, Eckel L, Kazim M, Godfrey K, Baxter SL, Korn BS, Kikkawa DO. Predictive Modeling of New-Onset Postoperative Diplopia Following Orbital Decompression for Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2022; 38:551-557. [PMID: 35551414 DOI: 10.1097/iop.0000000000002196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify risk factors for the development of new-onset, postoperative diplopia following orbital decompression surgery based on patient demographics, clinical exam characteristics, radiographic parameters, and surgical techniques. METHODS We conducted a multi-center retrospective chart review of patients who underwent orbital decompression for thyroid eye disease (TED). Patient demographics, including age, gender, smoking history, preoperative exophthalmometry, clinical activity score (CAS), use of peribulbar and/or systemic steroids, and type of orbital decompression were reviewed. Postoperative diplopia was determined at a minimum of 3 months postoperatively and before any further surgeries. Cross-sectional area ratios of each extraocular muscle to orbit and total fat to orbit were calculated from coronal imaging in a standard fashion. All measurements were carried out using PACS imaging software. Multivariable logistic regression modeling was performed using Stata 14.2 (StataCorp, College Station, TX). RESULTS A total of 331 patients without preoperative diplopia were identified. At 3 months postoperatively, 249 patients had no diplopia whereas 82 patients developed diplopia. The average postoperative follow-up was 22 months (range 3-156) months. Significant preoperative clinical risk factors for postoperative diplopia included older age at surgery, proptosis, use of peribulbar or systemic steroids, elevated clinical activity score, and presence of preoperative compressive optic neuropathy. Imaging findings of enlarged cross-sectional areas of each rectus muscle to the overall orbital area also conferred a significant risk of postoperative diplopia. Regarding surgical factors, postoperative diplopia was more common among those undergoing medial wall decompression, bilateral orbital surgery, and balanced decompression, whereas endoscopic medial wall decompression was found to be relatively protective. CONCLUSIONS This study identifies risk factors associated with the development of diplopia following orbital decompression using multivariable data. This study demonstrates that several characteristics including age, clinical activity score, the cross-sectional muscle to orbit ratios, in addition to the type of orbital decompression surgery, are predictive factors for the development of new-onset postoperative diplopia.
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Affiliation(s)
- Archana A Nair
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Lilangi S Ediriwickrema
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey Law
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences and Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Ali Mokhtarzadeh
- Department of Ophthalmology and Visual Neurosciences and Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Krista Stewart
- Department of Ophthalmology and Visual Neurosciences and Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Clara Men
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Mark J Lucarelli
- Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service, University of Wisconsin-Madison, Madison, Wisconsin
| | - Suzanne van Landingham
- Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maxwell Wingelaar
- Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rohan Verma
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Allison Chen
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Dinesh Selva
- Department of Ophthalmology, Adelaide Skin and Eye Centre, University of Adelaide, Adelaide, Kent Town, South Australia
| | - James Garrity
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Laurence Eckel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Michael Kazim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York
| | - Kyle Godfrey
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York
| | - Sally L Baxter
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California
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Li TY, Wang Y. [The treatment effect of maximal orbital decompression surgery and intravenous glucocorticoids pulse therapy for dysthyroid optic neuropathy]. Zhonghua Yan Ke Za Zhi 2022; 58:669-675. [PMID: 36069086 DOI: 10.3760/cma.j.cn112142-20220114-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To evaluate the efficacy and safety of maximal orbital decompression surgery and intravenous glucocorticoid (ivGC) pulse therapy as the initial treatment for dysthyroid optic neuropathy (DON). Methods: Retrospective cohort study. Forty-three patients (66 eyes) with DON who were treated during April 2019 and November 2021 in Peking University People's Hospital were included. According to the treatment methods, they were divided into the glucocorticoid group (21 cases, 33eyes) and the surgery group (22 cases, 33eyes). The glucocorticoid group received a total dose of 7.5 g ivGC therapy, while the surgery group received maximal orbital decompression surgery. Clinical outcomes were recorded and assessed including pre-and post-treatment logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA), clinical activity score (CAS), visual evoked potential (VEP)-P100 wave amplitude and peak time, muscle index (MI), and clinical proptosis. Adverse effects were also recorded. Follow-up data at 6 months after surgery or ivGC therapy were used as the post-treatment data. Wilcoxon signed rank analysis, independent or paired sample t test, Mann-Whitney U test, Chi-square test were used for statistical analysis. Non-normal distribution data were expressed in M(IQR). Results: There was no significant difference (all P>0.05) between the two groups in terms of gender, age, course of disease or laterality, as well as baseline data such as pre-treatment BCVA, CAS, VEP-P100 wave amplitude and peak time, and MI. After treatment, logMAR BCVA of the glucocorticoid group increased significantly from 1.00 (0.65) to 0.70 (0.60), (Z=-4.55), while BCVA of the surgery group increased significantly from 1.00 (0.95) to 0.60 (0.55), (Z=-4.87). The post-treatment CAS of the glucocorticoid group decreased significantly from 5 (2) to 2 (2) (Z=-4.91), while that of the surgery group also decreased significantly from 5 (2) to 2 (2) (Z=-4.94). After treatment, the VEP-P100 wave amplitude of the glucocorticoid group increased significantly from (3.49±1.34) μV to (5.26±2.00) μV (t=-9.08), while that of the surgery group increased significantly from (3.21±1.74) μV to (4.78±2.36) μV (t=-9.24). After treatment, the P100 wave peak time of the glucocorticoid group was significantly shortened from (110.52±12.11) ms to (103.53±6.67) ms (t=4.67), while that of the surgery group was significantly shortened from (118.48±20.16) ms to (106.45±10.57) ms (t=2.84). There were significant differences between inner-group before and after treatment data (all P<0.001), whereas the inter-group after treatment data have no significant difference (all P>0.05). The orbital apex crowding relief (MI≤0.52) rate was 64% (21/33) in the glucocorticoid group and was 91% (30/33) in the surgery group, while the proportion of proptosis reduction (more than 2 mm) in the glucocorticoid group and the surgery group was 64% (21/33) and 94% (31/33), respectively. Surgery was better than ivGC therapy both in terms of orbital apex crowding relief and proptosis reduction (χ2=5.52, 7.34; both P<0.05). Serious adverse effects or complications occurred in none of the two groups. Mild adverse effects occurred in 38% (8/12) of the patients receiving glucocorticoids and in 59%(13/22) of the patients receiving surgical treatment, with no significant difference (P>0.05). Conclusions: Both maximal orbital decompression surgery and ivGC therapy can effectively improve the visual function and reduce the CAS of DON with high safety. Meanwhile, surgery has more advantages in relieving orbital apex crowding and reducing proptosis.
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Affiliation(s)
- T Y Li
- Department of Ophthalmology, Peking University People's Hospital, Eye Disease and Optometry Institute, Beijing Key Laboratory of Diagnose and Therapy of Retinal and Choroid Disease, College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Y Wang
- Department of Ophthalmology, Peking University People's Hospital, Eye Disease and Optometry Institute, Beijing Key Laboratory of Diagnose and Therapy of Retinal and Choroid Disease, College of Optometry, Peking University Health Science Center, Beijing 100044, China
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Fu W. Changes of Volume Parameters in the Treatment of Graves Ophthalmopathy by Endoscopic Transethmoidal Decompression of the Orbital Inner Wall Combined with Fat Decompression. Scanning 2022; 2022:8149247. [PMID: 36082172 PMCID: PMC9433250 DOI: 10.1155/2022/8149247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Objective To observe the orbital volume changes and the analysis of surgical effect of Graves orbitopathy (GO) after endoscopic medial wall decompression combined with muscle cone fat. Methods Twenty-two patients (30 eyes) with Graves orbital disease who visited the Department of Ophthalmology of Ningbo Medical Center from December 2019 to September 2021 were retrospectively collected. All patients were diagnosed as nonorganic active stage before operation, and all of them received endoscopic transethmoidal decompression of the medial orbital wall combined with intramuscular orbital fat decompression due to decreased vision, visual field defect or color vision disorder, and concomitant proptosis. Regular follow-up after operation. The curative effect is judged according to the degree of improvement of visual acuity, color vision, degree of correction of exophthalmos, diplopia, and other complications at 9 months after operation. Orbital CT combined with computer aided measurement software (Mimics 21) was used to measure the changes of orbital volume before and after exophthalmos surgery. The relationship between the value and eyeball regression is analyzed. Results Preoperative exophthalmos ranged from 17.4 mm to 27.6 mm, with an average of (22.08 ± 2.86) mm. The postoperative exophthalmos was 14-25 mm, with an average of (19.52 ± 3.10) mm. Among them, 7 eyes (23.3%) had exophthalmos regression less than 1 mm, 6 eyes (20%) had a regression of 1-2 mm, 7 eyes (23.3%) had a regression of 2-3 mm, 5 eyes (16.7%) had a regression of 3-4 mm, and 5 eyes (16.7%) had a regression of 4-5.3 mm. The exophthalmos after operation was significantly lower than that before operation, and the difference was statistically significant (t = 9.909, P < 0.05). The preoperative orbital volume was 18.6 cm3-25.3 cm3 with an average of (22.39 ± 1.91) cm3. The postoperative orbital volume was 19.8 cm3-26.6 cm3, with an average of (23.89 ± 1.90) cm3.The orbital volume change range is 0.1 cm3-3.8 cm3, and the average orbital volume change is (1.51 ± 1.00) cm3. Compared with preoperative orbital volume, the difference was statistically significant (t = -8.074, P < 0.05). Conclusion Endoscopic decompression of the medial orbital wall through the ethmoid approach combined with decompression of the orbital fat within the muscle cone can effectively correct the exophthalmos while decompressing the orbital apex, and it is minimally invasive and has no facial scars. It has the advantages of extremely low incidence of postoperative diplopia and eye shift. There is a significant correlation between orbital volume changes and the regression of exophthalmos, which can provide reference for clinical guidance of surgical methods and prediction of surgical results.
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Affiliation(s)
- Weina Fu
- Department of Ophthalmology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang 315040, China
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Abstract
Objective: Our aim was to present a rare case of a middle-aged male patient, diagnosed with Graves’ orbitopathy, which had an atypical rapid unilateral onset. Initially, the left eye presented exophthalmos, eyelid retraction, corneal ulceration, and pannus formation with an important vascular component due to corneal exposure. The same symptoms developed in the right eye within a short period of time. Methods: A 52-year-old man presented in our department with bilateral proptosis, decrease in visual acuity, and orbital pain, which developed initially in the left eye seven months before the right eye. Slit lamp examination revealed conjunctival hyperemia, purulent discharge, chemosis and inflammation of the caruncle in both eyes. The fluorescein eye stain test was positive due to corneal ulceration with the presence of cells and flare in anterior chamber in the RE (right eye). The LE (left eye) presented a corneal pannus. We documented the changes using a slit lamp biomicroscope, a fundus camera, orbital ultrasonography, and contrast CT (computer tomography) scans. Discussions: The severe Graves’ ophthalmopathy represents a challenge both in active or inactive phase. Medical and surgical therapies should be taken into consideration in order to prevent the complications following corneal perforation or optic neuropathy. Also, ophthalmic, and systemic adverse reactions of systemic steroids used in the treatment of Graves’ disease are important in the prognosis of the visual outcome. Conclusions: The management of Graves’ ophthalmopathy is multidisciplinary and needs a very good therapy adherence in order to achieve a satisfactory prognosis and quality of life.
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Hwang B, Heo H, Lambert SR. Risk Factors for Reoperation after Strabismus Surgery among Patients with Thyroid Eye Disease. Am J Ophthalmol 2022; 238:10-15. [PMID: 34843685 PMCID: PMC9135959 DOI: 10.1016/j.ajo.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine risk factors for strabismus surgery reoperation in patients with thyroid eye disease (TED). DESIGN Retrospective cohort study. METHODS An insurance claims database was used to identify patients with TED who underwent at least one strabismus operation between 2003 and 2019. We recorded specific muscles operated on, as well as the timing and frequency of reoperations. Cox regressions were used to estimate associations between time to reoperation and patient and primary surgery characteristics. RESULTS Of the 448 patients who met inclusion criteria, 111 (24.8%) underwent a reoperation. Patients were followed for an average of 5.4 ± 3.0 years after their initial strabismus surgery. The rates of reoperation among patients whose initial surgery involved horizontal muscles only, vertical muscles only, and horizontal and vertical muscles were 29 of 120 (24.2%), 33 of 169 (19.5%), and 49 of 159 (30.8%) respectively (P = .05). The number of muscles operated on initially was the only independent predictor for undergoing a strabismus surgery reoperation (odds ratio, 1.27; 95% confidence interval, 1.03-1.57; P = .03). The number of muscles operated on initially was also associated with shorter time to first reoperation (hazard ratio, 1.22; 95% confidence interval, 1.02-1.46; P = .03). Age at first surgery, time between diagnosis of TED and first strabismus surgery, gender, race, and use of adjustable sutures were not associated with time to reoperation. CONCLUSIONS Approximately 1 in 4 patients with TED require reoperation after strabismus surgery. The number of muscles operated on was the only independent predictor for both undergoing a reoperation and time to first reoperation.
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Affiliation(s)
- Bryce Hwang
- From the Department of Ophthalmology, Stanford University School of Medicine (B.H., H.H., S.R.L.), Palo Alto, California, USA
| | - Hwan Heo
- From the Department of Ophthalmology, Stanford University School of Medicine (B.H., H.H., S.R.L.), Palo Alto, California, USA; and the Department of Ophthalmology, Chonnam National University Medical School and Hospital (H.H.), Gwangju, Republic of Korea
| | - Scott R Lambert
- From the Department of Ophthalmology, Stanford University School of Medicine (B.H., H.H., S.R.L.), Palo Alto, California, USA.
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Hall AJH, Topliss DJ. COVID‐19 VACCINE RESPONSE IN PATIENTS ON CANCER THERAPY ‐ EVIDENCE FROM AUSTRALIAN DATA. Intern Med J 2022. [PMID: 32975863 PMCID: PMC9347487 DOI: 10.1111/imj.26_15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anthony J H Hall
- Department of Ophthalmology, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Duncan J Topliss
- Department of Endocrinology and Diabetes, The Alfred, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Hierl KV, Krause M, Kruber D, Sterker I. 3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex. PLoS One 2022; 17:e0265324. [PMID: 35275980 PMCID: PMC8916626 DOI: 10.1371/journal.pone.0265324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/01/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Methods Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Results Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. Conclusion In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.
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Affiliation(s)
| | - Matthias Krause
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Daniel Kruber
- Department of Informatics and Media, Leipzig University of Applied Sciences, Leipzig, Germany
| | - Ina Sterker
- Department of Ophthalmology, Leipzig University, Leipzig, Germany
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Men CJ, Gur Z, Ko AC, Liu CY, Korn BS, Kikkawa DO. Lateral Wall Implant as an Adjunct to Lateral Wall Orbital Decompression in Severe Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2022; 38:146-150. [PMID: 34293782 DOI: 10.1097/iop.0000000000002007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the use of a lateral wall implant as an adjunct in lateral orbital wall decompression in severe thyroid eye disease. METHODS This study is a retrospective review of 6 patients who underwent prior orbital decompression but had persistent proptosis. These patients underwent lateral wall decompression with adjunct lateral wall implant placement with a manually vaulted 0.6-mm polyethylene-coated titanium mesh implant. Data collection included: visual acuity, intraocular pressure, exophthalmometry, ocular motility, eyelid position, and complication rates. RESULTS Eight orbits in 6 patients underwent maximal lateral wall decompression and reconstruction using the polyethylene-coated titanium implant. Four males and 2 females were included with ages ranging from 25 to 73 years. Visual acuity improved an average of 2.4 lines (range 0-5 lines). Intraocular pressure improved an average of 7.5 mm Hg (2-13 mm Hg). There was reduction of proptosis by 3.4 mm on average (1-7 mm). Upper eyelid retraction improved on average by 1.8 mm (0-5 mm). Horizontal eye movements improved by 11% on average (-3.1% to +25%). Excellent cosmesis was achieved with no visible temple deformity, trismus, conjunctival scarring, orbital hemorrhage, or vision loss. CONCLUSIONS The amount of volume created in lateral wall decompression is limited by the amount of native bone present and the temporalis muscle. In severe or recalcitrant cases, the authors propose the placement of a lateral wall implant as an adjunct to laterally displace the temporalis muscle and create additional volume. This technique accomplishes further reduction of proptosis in patients who have undergone prior orbital decompression.
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Affiliation(s)
- Clara J Men
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
| | - Zvi Gur
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
| | - Audrey C Ko
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, U.S.A
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Rotondo Dottore G, Torregrossa L, Lanzolla G, Mariotti S, Menconi F, Piaggi P, Cristofani Mencacci L, Posarelli C, Maglionico MN, Dallan I, Figus M, Nardi M, Marcocci C, Basolo F, Marinò M. Role of the mononuclear cell infiltrate in Graves' orbitopathy (GO): results of a large cohort study. J Endocrinol Invest 2022; 45:563-572. [PMID: 34671950 DOI: 10.1007/s40618-021-01692-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The extent to which mononuclear cells and TSH-receptor autoantibodies (TRAb) contribute to Graves' orbitopathy (GO) is not completely defined. Here we investigated the relationship between the immunohistochemical phenotype of orbital infiltrating cells and GO features in a large number of patients. METHODS We conducted an observational cohort study in 76 consecutive patients with GO (16 men and 60 women) who underwent orbital decompression over a period of 18 consecutive months. An ophthalmological evaluation was performed in all patients, as well as immunohistochemistry for CD3, CD4, CD8, CD56 (T-cell markers), CD25 (T and B-cell marker), CD20, CD19 (B-cell markers), and CD138 (plasmacell marker) in specimens collected at decompressive surgery. RESULTS Having established cutoff values for each marker, cell infiltrates were found in 60 patients (78.9%; CD3: 39.4%, CD4 55.2%, CD8 50%, CD56: 0%, CD25: 28.9%, CD20: 51.3%, CD19: 25%, CD138: 26.3%). Eleven (14.4%) stained exclusively for CD138 (plasmacells). Patients with CD4-positive mononuclear cells had a significantly greater GO clinical activity score (CAS) (mean difference 1.07, 95% CI - 0.33 to - 1.82, P = 0.004 by univariate, P = 0.05 by multivariate analysis). CAS as well as the remaining GO features were not affected significantly by the mononuclear cell subpopulations in multivariate analyses. CONCLUSIONS Mononuclear cell infiltrates are present in the majority of GO patients, with a small percentage represented exclusively by plasmacells. CD4 cells exert a major role on GO activity. These findings may represent a further advancement in the comprehension of GO pathogenesis.
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Affiliation(s)
- G Rotondo Dottore
- Department of Clinical and Experimental Medicine, Endocrinology Units, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - L Torregrossa
- Department of Surgical, Medical and Molecular Pathology, Pathology Unit, University of Pisa and University Hospital of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - G Lanzolla
- Department of Clinical and Experimental Medicine, Endocrinology Units, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - S Mariotti
- Retired. Formerly Department of Medical Sciences and Public Health, University of Cagliari, SS 554 Bivio per Sestu, Monserrato, 09042, Italy
| | - F Menconi
- Department of Clinical and Experimental Medicine, Endocrinology Units, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - P Piaggi
- Department of Information Engineering, University of Pisa and University Hospital of Pisa, Via G. Caruso 16, Pisa, 56122, Italy
| | - L Cristofani Mencacci
- Department of Surgical, Medical and Molecular PathologyENT Unit I, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - C Posarelli
- Department of Surgical, Medical and Molecular PathologyOphthalmology Unit I, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - M N Maglionico
- Department of Surgical, Medical and Molecular PathologyOphthalmology Unit I, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - I Dallan
- Department of Surgical, Medical and Molecular PathologyENT Unit I, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - M Figus
- Department of Surgical, Medical and Molecular PathologyOphthalmology Unit I, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - M Nardi
- Department of Surgical, Medical and Molecular PathologyOphthalmology Unit I, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, Endocrinology Units, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - F Basolo
- Department of Surgical, Medical and Molecular Pathology, Pathology Unit, University of Pisa and University Hospital of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Units, University Hospital of Pisa, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy.
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Guastella C, di Furia D, Torretta S, Ibba TM, Pignataro L, Accorona R. Upper Eyelid Retraction in Graves' Ophthalmopathy: Our Surgical Experience on 153 Cases of Full-Thickness Anterior Blepharotomy with Mullerectomy. Aesthetic Plast Surg 2022; 46:1713-1721. [PMID: 35129648 DOI: 10.1007/s00266-022-02770-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We present our experience on 153 cases of full-thickness anterior blepharotomy with mullerectomy (FTABM) in the treatment of upper eyelid retraction (UER) related to Graves' ophthalmopathy (GO). METHODS We included all the patients who underwent a graded FTABM between 1st January 2015 and 30th June 2020 for UER GO-related. The analysis included: pre-/post-operative conjunctival symptoms, epiphora, GO-Quality of Life Questionnaire (QoL), lagophthalmos, marginal reflex distance (MRD-1) index, eyelid symmetry within 1mm. The statistical analysis was designed to detect postoperative improvement in objective and subjective clinical features. Outcomes were analysed through Chi-squared test for dichotomous variables and through Wilcoxon-Mann-Whitney test for continuous variables. RESULTS Of the 111 patients, 42 underwent a bilateral procedure, while 69 a monolateral. Conjunctival symptoms were reported in 32% of cases before surgery and in 12.4% after FTABM (p < 0.001). Epiphora was complained by 29.6% of patients preoperatively and in 12.4% postoperatively (p < 0.001). Preoperative lagophthalmos was found in 12.4% (mean value of 0.34 ± 0.76 mm) of eyelids, and in 2.6% (mean value 0.05 ± 0.19 mm) eyelids (p = not significant) postoperatively. Pre-operative GO-QoL was 24.9 ± 4.4 mm; while post-operative GO-QoL was 35.3 ± 5.5 mm (p < 0.001). The MRD-1 varied from 10.12 ± 2.1 mm preoperatively, to 4.3 ± 0.6 mm (p < 0.001) after surgery. Asymmetric palpebral fissure was noted in 94 (84.7%) patients before surgery and in 7 (6.3%) after the procedure (p < 0.001). CONCLUSION FTABM is an effective procedure to treat UER GO-related. The technique manages to prevent complications of UER and determine good aesthetics. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Level IV, therapeutic study.
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Affiliation(s)
- Claudio Guastella
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Referral Centre for Graves' Ophthalmopathy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Domenico di Furia
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Sara Torretta
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Tullio Mattia Ibba
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
| | - Lorenzo Pignataro
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Referral Centre for Graves' Ophthalmopathy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Remo Accorona
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy.
- Referral Centre for Graves' Ophthalmopathy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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Woo T, Li C, Ganesananthan S, Rajendram R, Uddin J, Lee RWJ, Dayan C, Taylor P. The Effect of Ophthalmic Surgery for Graves' Orbitopathy on Quality of Life: A Systematic Review and Meta-Analysis. Thyroid 2022; 32:177-187. [PMID: 34877883 DOI: 10.1089/thy.2021.0411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Graves' orbitopathy (GO) has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia, and improve aesthetics. We sought to quantify the effect of different surgical approaches on quality of life. Methods: Electronic databases Ovid-MEDLINE and EMBASE were used from inception until March 22, 2021, to identify studies assessing quality of life pre- and postsurgical intervention for GO. Two reviewers independently extracted data and performed quality assessments. Random-effects and Bayesian models for meta-analyses were utilized. Results: Ten articles comprising 632 patients with a mean age of 48.4 years (range 16-85 years) were included. All used the Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire. For GO-QOL appearance, the pooled standardized mean improvement for patients after surgery was +0.72 (95% confidence interval [CI 0.50-0.94]), I2 = 69% [CI 52-80%]. For GO-QOL visual functioning, the pooled standardized mean difference (SMD) for patients after surgery was +0.41 [CI 0.25-0.58], I2 = 60% [CI 36-74%]. For visual appearance, orbital decompression yielded the greatest improvement (SMD +0.84 [CI 0.54-1.13]) followed by eyelid surgery (SMD +0.38 [CI 0.05-0.70]), while strabismus correction had no significant effect (SMD +0.94 [CI -0.10 to 1.99]). Conversely strabismus correction was associated with the greatest improvement (SMD +1.25 [CI 0.29-2.21]) in visual functioning, outperforming orbital decompression (SMD +0.29 [CI 0.15-0.43]) and eyelid surgery (SMD +0.12 [CI -0.18 to 0.41]). A mean improvement in GO-QOL of greater than 10 points after orbital decompression surgery was achieved in 12/14 (86%) patient groups for appearance and 5/14 (36%) patient groups for visual functioning. A mean improvement of greater than 6 points was achieved in 5 of 6 (83%) patient groups for strabismus surgery for both appearance and visual functioning. A mean improvement of greater than 6 points after eyelid surgery was achieved in 2/3 (67%) patient groups and 0/3 patient groups for visual appearance and functioning, respectively. Conclusion: Ophthalmic surgery results in substantial improvements in quality of life in patients with GO, with greater perceived effects on appearance than visual function. Orbital decompression has particular impact on visual appearance; strabismus surgery may benefit both visual appearance and function equally, whereas eyelid surgery benefits appearance alone.
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Affiliation(s)
- Timothy Woo
- Department of Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - ChunHei Li
- Department of Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | - Rathie Rajendram
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Jimmy Uddin
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard W J Lee
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Colin Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Peter Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
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Abstract
Thyroid eye disease is an autoimmune inflammatory disease strongly associated with thyroid disease, principally Graves disease. It can range from mild disease requiring observation or symptomatic treatments only, through to sight-threatening disease requiring major drug therapy and orbital surgery. Severity is graded by the NOSPECS system and activity by the clinical activity score (CAS) to assist in treatment selection. Non-surgical management can extend from observation alone to minor therapy such as oral selenium, then glucocorticoid therapy, cyclosporin, mycophenolate, rituximab, immunoglobulin, teprotumumab, and orbital radiotherapy. High-dose intravenous methylprednisolone therapy is used in active vision-threatening disease with early use of tarsorrhaphy and orbital decompression. Inactive but moderate to severe disease may be treated by orbital decompression, strabismus and eyelid surgery. Systematic assessment and management by both an endocrinologist and ophthalmologist to achieve and maintain euthyroidism and select and sequence treatments according to activity and severity of thyroid eye disease gives the best results for quality of life and vision.
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Affiliation(s)
- Anthony J H Hall
- Department of Ophthalmology, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Duncan J Topliss
- Department of Endocrinology and Diabetes, The Alfred, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Grusha YO, Dzamikhov IK. [The significance of surgical anatomy in lateral orbital wall decompression]. Vestn Oftalmol 2022; 138:289-292. [PMID: 36287170 DOI: 10.17116/oftalma2022138052289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The article reviews data on the anatomical and topographic features of the lateral wall in the context of performing orbital surgery and presents a description of the surgical areas of the lateral wall that are most important for increasing the volume of the orbit: the lacrimal keyhole, the sphenoid door jamb, and the basin of the inferior orbital fissure. Particular attention is given to the topographic anatomy of the sphenoid door jamb as the most promising area for orbital decompression and transorbital access to the skull base.
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Affiliation(s)
- Y O Grusha
- Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - I K Dzamikhov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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