Blood–aqueous barrier integrity in patients with Graves’ ophthalmopathy (GO), before and after rehabilitative surgery

Abstract

Background The study was conducted to analyze aqueous flare and it’s correlations in patients with Graves’ ophthalmopathy, undergoing orbital decompression, extra-ocular muscle and eyelid surgery. Prospective interventional case series. Materials and Methods 48 eyes of 27 patients(20 female and 7 male, aged 54.4±5.7), undergoing surgical treatment for GO. 18 eyes of 9 patients (aged 55.3±3.6) undergoing orbital decompression. 19 eyes of 11 patients (aged 54.7±5.6) undergoing extraocular muscle surgery and 13 eyes of 7 patients (aged 53.9±4.9) undergoing eyelid surgery and control group (34 patients aged 53.9±5.1). Laser flare analysis, and clinical assessment was performed before surgery and 1 day, 7 days and 3 months following surgery. Results Aqueous flare was significantly higher in patients with GO (14.03 ± 8.45), before intervention than in the control group (7.89 ± 3.56) (p<0.001), and correlated with Clinical Activity Score and intraocular pressure. In the patients undergoing orbital decompression, flare increased from 17.77±10.63 pc/ms to 38.32±13.56 pc/ms on the first day, and 41.31±17.19 pc/ms on the seventh day and returned to 16.01±8.58 pc/ms in 3 months. In patients undergoing extra-ocular muscle surgery flare increased from 13.05±6.50pc/ms to 23.04±11.53 pc/ms (p<0.001) on the first day, and returned to 18.02±14.09pc/ms on the seventh day. Eyelid surgery did not change flare values. Conclusions Orbital decompression disrupts blood-aqueous barrier. The integrity of blood-aqueous barrier returns to pre-operative status within three months. Extraocular muscle surgery mildly affects blood aqueous barrier integrity, and the effect subsides within seven days. Eyelid surgery does not affect blood-aqueous barrier.

Evaluation of Aqueous Flare in Graves’ Ophthalmopathy and its Relationship with Thyroid Hormones, Antibodies, and Clinical Activity Score

“…The fibrotic phase following the inflammatory phase causes problems such as extraocular muscle movement limitation, intermittent or persistent diplopia, and lid retraction, requiring a series of surgical interventions. The only study on this subject in the literature was by Kłysik and Kozakiewicz who compared pre- and post-operative measurements of aqueous flare in patients with GO who had undergone orbital decompression surgery, strabismus surgery, and eyelid surgery ( 19 ). In their studies, baseline flare values were measured as 18.25, 13.05, and 10.14, respectively.…”