Recognizing the Protruding Eye

Lin, Lily Koo; Andreoli, C. M.; Hatton, Mark P.; Rubin, Peter A. D.

doi:10.1080/01676830802336645

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…The reduction of asymmetry to below 2 mm may be significant, since in a previous study it was found that only asymmetry (due to proptosis) greater than 2 mm, was noticeable by observers. 31 Further, this study indicates that this balancing of symmetry does not occur during the natural short-term course of the disease. The teprotumumab-treated asymmetric patients demonstrated significant reductions in proptosis, CAS and diplopia in both orbits of each patient and this was not seen with placebo.…”

Section: Discussionmentioning

confidence: 63%

Improvement of asymmetric thyroid eye disease with teprotumumab

et al. 2021

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PurposeTeprotumumab, a specific blocking antibody to the insulin like growth factor 1 receptor, significantly reduced proptosis in patients with thyroid eye disease (TED) in recent clinical trials. Given its specificity, we expect it to demonstrate greater efficacy on the worse affected orbit, in patients with asymmetric TED. Herein, we investigate the differential impact of teprotumumab on the orbits of such patients.MethodsIn this pooled analysis of patients who were enrolled in the recent phase 2 (NCT01868997) and phase 3 (NCT03298867) trials, all patients with asymmetric TED (difference in exophthalmometry of ≥3 mm) were screened for eligibility. The primary outcomes of the trials, proptosis, diplopia and Clinical Activity Score (CAS) response, were evaluated in both orbits of patients who had received treatment or placebo, to examine the differential response from baseline to week 24.ResultsFrom a pooled group of 84 patients randomised to receive teprotumumab and 87 randomised to placebo, 10 (12%) and 12 (14%), respectively, met the inclusion criteria. The teprotumumab-treated patients demonstrated significant reductions in proptosis, CAS and diplopia in both orbits of each patient and this was not seen with placebo. The reduction in proptosis and CAS was significantly greater in the worse affected orbit, improving symmetry. In the placebo arm, while the mean CAS in the study eye reduced over time, proptosis and diplopia did not change in either orbit.ConclusionThe findings in this study suggest the differential impact of teprotumumab on orbits that are clinically more affected by TED, suggesting that teprotumumab reduces asymmetry.

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Section: Discussionmentioning

confidence: 63%

Improvement of asymmetric thyroid eye disease with teprotumumab

et al. 2021

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“…In a clinical setting, subtle exophthalmos is usually detected using the observer experience. In humans, for instance, the point at which exophthalmos becomes clinically perceptible to the majority of examiners is about 4 mm (in relation to controls – normal subjects) . Most investigations that describe iatrogenic exophthalmos also do so subjectively .…”

Section: Discussionmentioning

confidence: 99%

A morphometric study of the canine skull and periorbita and its implications for regional ocular anesthesia

Klaumann

Moreno

Montiani‐Ferreira

2017

Veterinary Ophthalmology

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Objective A hypothetical relationship between canine cranial length and the length of the periorbita could be used for intraconal anesthetic volume estimation. Study subjects Forty-one canine cadaver heads and one macerated dog skull. Procedures Inion and nasion points were recognized in the macerated skull and used as landmarks for cranial length measure. Thirty cadavers classified as dolichocephalic, mesaticephalic and brachycephalic were distributed in three study groups. Anatomic references of the skull shapes were recognized and parameters measured: body weight (BW), cranial length (L cr ) and length of the periorbita (L po ). Results were compared and statistical analyses were performed to find correlations between BW and the skull parameters. Contrast medium was injected in another 11 cadavers with a total volume calculated based on L cr (10 cadavers) or BW (one cadaver) and then submitted to computerized tomography examination to compare techniques, estimate the capacity of the intraconal space of the periorbita and to illustrate practical implications. Results There is a positive correlation between BW and L po (P < 0.001) as well as between L cr and L po (P < 0.0001). Linear regression of the variable BW predicts only 71% of the variable L po (r 2 = 0.71), whereas the variable L cr predicts 88% (r 2 = 0.88)Conclusions This study demonstrated a mathematical relation between L cr and L po . A method for calculating anesthetic solution volumes based on canine morphometric features is presented. The formula 0.1 mL/cm L cr to calculate total intraconal anesthetic volume is suggested.

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“…However, tocilizumab failed to significantly improve diplopia. Furthermore, the median reduction in proptosis at Week 16 was only 1.5 mm, which may not be clinically significant (22). Furthermore, 93 adverse events were reported among 27 patients: the most common being headache (11 tocilizumab vs 4 placebo) and infection (17 vs 7).…”

Section: Evolving Concepts In the Management Of Thyroid Eye Diseasementioning

confidence: 99%

A Paradigm Shift in the Management of Thyroid Eye Disease How Teprotumumab Has Changed the Therapeutic Interface

Ugradar¹,

Kossler²,

Douglas³

et al. 2022

Journal of Neuro-Ophthalmology

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T eprotumumab is the first and only Food and Drug Administration (FDA)-approved medication for the treatment of thyroid eye disease (TED). At the time of writing, aside from the clinical information from the original trials on the safety and efficacy of teprotumumab (1-4), only a handful of clinical reports have been published (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). This review discusses the mechanism of action of teprotumumab and provides an overview of real-world experience with teprotumumab 21 months after the approval.

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Recognizing the Protruding Eye

Cited by 7 publications

References 19 publications

Improvement of asymmetric thyroid eye disease with teprotumumab

Improvement of asymmetric thyroid eye disease with teprotumumab

A morphometric study of the canine skull and periorbita and its implications for regional ocular anesthesia

A Paradigm Shift in the Management of Thyroid Eye Disease How Teprotumumab Has Changed the Therapeutic Interface

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