Evaluation of retinal and choroidal variations in thyroid-associated ophthalmopathy using optical coherence tomography angiography

Abstract

Background To investigate the difference in retinal nerve fiber layer (RNFL) thickness, choroidal thickness (CT) and superficial retinal vessels between thyroid-associated ophthalmopathy (TAO) patients and healthy controls. To identify the potential influencing factors for these parameters and evaluate their diagnostic abilities in TAO. Methods Twenty active TAO patients, 33 inactive TAO patients and 29 healthy participants were enrolled. TAO patients were divided according to the clinical activity score (CAS). RNFL thickness and CT were measured by HD-OCT, while foveal avascular zone (FAZ), vascular density and perfusion density were measured by optical coherence tomography angiography (OCTA). SPSS software was used for statistical analysis. Results Active TAO patients had thinner RNFL thickness than the other two groups (P < 0.001, P < 0.001). Both active and inactive TAO patients had significantly higher CT in the macular region (all P < 0.05). The FAZ area in the active TAO group was significantly larger than the other two groups (P = 0.045, P = 0.001). The inactive TAO group had significantly higher vascular density than the other two groups (all P < 0.05). With regard to the perfusion density, significant differences were observed in the temporal and inferior areas (P = 0.045, P = 0.001), as well as the average values (P = 0.032). The FAZ area was positively correlated with intraocular pressure (r = 0.274, P = 0.013), while it was negatively correlated with axial length (r = − 0.344, P = 0.002). The vascular density and perfusion density were not significantly correlated with different clinical variables (all P > 0.05). The AUC analysis indicated these parameters also exhibited a significant discriminatory power in TAO diagnosis. Conclusions TAO patients had significant variations in RNFL thickness, choroidal thickness, FAZ area and superficial retinal vessels. These parameters appeared to be potential adjuncts in the evaluation of TAO patients.

Evaluation of macular blood flow after intermittent intravenous infusion of high-dose corticosteroids (pulse therapy) in patients with thyroid-associated orbitopathy (TAO) using angio-OCT

“…They observed that patients with TAO had significant changes in RNFL thickness, choroidal thickness and superficial retinal vessels. Patients with inactive TAO had greater retinal vascular density than healthy controls [21].…”

Alterations in Spontaneous Neuronal Activity and Microvascular Density of the Optic Nerve Head in Active Thyroid-Associated Ophthalmopathy

“…ONH vessel density and pRNFL thickness are measured by OCT-A and are useful in identifying TAO patients with DON, the most common vision-threatening condition in TAO and damaged optic nerves (23). It is reported that retinal nerve fiber layer thickness correlates with vascular density and the disease activity of TAO (1). Past studies show that altered fALFF in specific brain regions (left cuneus, bilateral superior frontal gyrus) correlates with RNFL thickness in patients with primary angle-closure glaucoma, suggesting that these finding are conducive to assessing the disease severity (16).…”

“…Thyroid-associated ophthalmopathy (TAO), commonly known as Graves' ophthalmopathy or thyroid eye disease, is an organspecific, progressive autoimmune inflammatory disease affecting the orbital. TAO is the commonest autoimmune orbital illness in adults (1,2) and often involves both orbits, with an asymmetrical appearance (3,4). The most common ophthalmic consequences in TAO patients are periorbital edema, upper eyelid retraction, diplopia, exophthalmos, dysfunctional eye movement, and impaired visual function (5)(6)(7)(8)(9).…”

“…Because it is safer, faster, and non-invasive, OCTA is widely used to diagnose and monitor retinal microvascular pathology in various diseases, including diabetic retinopathy, macular edema, and TAO (21,22). Ophthalmological parameters, including microvascular detail and parapapillary retinal nerve fiber layer (pRNFL) thickness, can reflect the activity and severity of TAO (1,23). Therefore, it is worth exploring whether ophthalmological parameters using OCTA correlate with altered fALFF values.…”

Change of intraocular blood flow during treatment for thyroid eye disease

“…Recent reports have been focused on the retinal perfusion on TED patients to demonstrate early subclinical signs of the disease. [ 2 3 4 5 6 7 8 9 ] However, controversy exists as to whether the perfusion is decreased[ 2 3 ] or increased. [ 4 6 ] This discrepancy may be due to cross-sectional studies comparing the TED patients and controls, and also that vascular perfusion may vary based on the systemic condition of the patient, intraocular pressures (IOP), and inflammatory status of the orbit.…”