Change of intraocular blood flow during treatment for thyroid eye disease

Abstract

To report a sequential observational study of changes in the retinal and choroidal blood flow during medical and surgical treatments for a thyroid eye disease (TED) patient, using optical coherence tomography angiography (OCTA) and laser speckle flowgraphy (LSFG). A 28-year-old man with a history of Graves’ disease diagnosed 8 months prior was presented in the active phase of TED. His clinical activity score (CAS) was 6, but without diplopia or visual loss. Intraocular pressure measurement was OD 20 mmHg and OS 24 mmHg. Thyrotropin receptor antibody (TRAb) and thyroid-stimulating antibody levels were 18.8 IU/L and 4347%. Magnetic resonance imaging revealed enlargement of both extraocular muscles and fat compartments in both orbits. The patient underwent IV pulsed steroid therapy (1 g/day, 3 days) followed by an oral prednisone for 1 month. His CAS score decreased to 4. Bilateral orbital fat decompression decreased his final CAS score to 1 in both eyes. Intraocular blood flow was measured using laser speckle flowgraphy (LSFG), and OCTA was performed. Retinal blood flow increased slightly, but choroidal blood flow showed a robust increase. Choroidal blood flow measured using both LSFG and OCTA was negatively correlated with the CAS score and TRAb. In our case report, the ocular perfusion, especially choroidal blood flow, may decrease in active TED, which may be reversed by medical and surgical treatment.

Macular microvasculature in patients with thyroid-associated orbitopathy compared to healthy individuals, foveal avascular zone area as a biomarker for disease activity

“…The differences in vessel diameter and regional autoregulatory mechanisms in these two layers of the retina may be the cause of this discrepancy. However, most of the previous studies show the declining trend of vascular density in both the super cial and deep layers of the retina with increasing severity of clinical involvement [19][20][21].…”

Macular microvasculature in patients with thyroid-associated orbitopathy: a cross-sectional study

“…The differences in vessel diameter and regional autoregulatory mechanisms between the superficial and deep capillary plexus of retina may be the cause of this discrepancy. However, most of the previous studies have shown a decrease in vascular density in both the superficial and deep layers of the retina with increasing severity of clinical involvement [ 19 – 21 ].…”