The Diagnosis and Treatment of Thyroid-Associated Ophthalmopathy

Gould, Daniel J.; Roth, F; Soparkar, Charles N. S.

doi:10.1007/s00266-011-9843-4

Cited by 21 publications

(14 citation statements)

References 53 publications

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“…Blepharoplasty is usually the final step in the rehabilitation of lid changes due to endocrine orbitopathy. Caution is required so as not to overlook disease in the early phase of endocrine orbitopathy and often not yet diagnosed as such and to operate at the patientʼs wishunsatisfactory results and complications are preprogrammed [31]. When correction is performed at the healed and stable stage, fat resection, possibly in the sub-brow area also, is usually indicated, whereas skin resection should be more restrained.…”

Section: Discussionmentioning

confidence: 99%

Eyelid Surgery in Gravesʼ Orbitopathy

Hintschich¹

2021

Klin Monbl Augenheilkd

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Patients with Gravesʼ orbitopathy often develop eyelid changes. These may be the result of a volume effect or a malposition. Both dermatochalasis with fat tissue increase and eyelid retraction may lead to functional or aesthetic impairment. The present article reviews indications, timing and principles for corrective eyelid surgery. If at all possible, surgical eyelid correction in Gravesʼ orbitopathy should be performed once the disease became inactive and stabile. Surgical details of eyelid lengthening procedures for upper and lower eyelid retraction are presented. Meanwhile anterior blepharotomy became the primary procedure for upper eyelid lengthening. However, there is no such standard procedure for lower eyelid lengthening, although it is recommended to use a spacer. For blepharoplasty it is mandatory to distinguish between orbital fat prolapse and subbrow fat pad. A prolapse of the lacrimal gland should not be missed and generally, skin excision performed sparingly.

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Section: Discussionmentioning

confidence: 99%

Eyelid Surgery in Gravesʼ Orbitopathy

Hintschich¹

2021

Klin Monbl Augenheilkd

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“…Active phase is characterized histopathologically by mononuclear cell infiltration, fibroblast proliferation, and edema in EOMs. In contrast, inactive phase is characterized by interstitial fibrosis and collagen deposition (2,3). Given that T2RT value could increase in edematous muscle and decrease in fibrotic tissue, it would not be surprising that active TAOs had prolonged T2RT of EOMs than that of inactive ones (26).…”

Section: Discussionmentioning

confidence: 99%

“…During its acute active phase, pathological inflammatory changes including mononuclear cell infiltration, edema, and fibroblast proliferation in orbital tissues can be present, and generally show good response to anti-inflammatory treatments (2). However, the contrary chronic and inactive phase is usually characterized by interstitial fibrosis with collagen deposition and fat infiltration, and surgical procedure is the only treatment option (3). Adequate and timely treatment in the active phase is critical for limiting both the severity of its chronic fibrotic sequelae and the progression of compressive sight-threatening optic neuropathy (4).…”

Section: Introductionmentioning

confidence: 99%

Utility of T2 mapping in the staging of thyroid-associated ophthalmopathy: efficiency of region of interest selection methods

Chen

et al. 2020

Acta Radiol

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Background Discriminating the stage of thyroid-associated ophthalmopathy (TAO) is crucial for the treatment strategy and prognosis prediction. Utility of conventional magnetic resonance imaging in the disease staging is limited. Purpose To investigate the performance of T2 mapping based on different region of interest (ROI) selection methods in the staging of TAO. Material and Methods Thirty-two patients with TAO were retrospectively enrolled. Two radiologists independently measured the T2 relaxation time (T2RT) of extraocular muscles using two different ROIs (hotspot [ROIHS]: T2RT-hot; single-slice [ROISS]: T2RT-mean, T2RT-max, T2RT-min). Independent-samples t test, Wilcoxon signed rank test, Spearman correlation analysis, receiver operating characteristic (ROC) curves analyses, multiple ROC comparisons, and intra-class correlation coefficient (ICC) were used for statistical analyses. Results No significant difference was found in the measuring time between ROIHS and ROISS methods ( P = 0.066). T2RT-mean demonstrated the highest ICC for measurement, followed by T2RT-max and T2RT-min, and T2RT-hot showed the poorest reproducibility. Active TAOs showed significantly higher values for all the T2RTs than inactive mimics (all P < 0.001). Significant positive correlations were found between T2RTs and CAS (all P < 0.005). T2RT-hot and T2RT-max showed significantly higher areas under the curve than that of T2RT-mean ( P = 0.013 and 0.024, respectively), while the difference between T2RT-hot and T2RT-max was not significant ( P = 0.970). Conclusion The T2RTs derived from both ROI selection methods could be useful for the staging of TAO. The results of measuring time, reproducibility, and diagnostic performance suggest that T2RT-max would be the optimal indicator for staging.

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“…However, TAO can only be diagnosed when morphological changes in the organization of the eye or eye muscles are observed (11). The cost of these inspection methods is high, and they are not suitable for use as early screening tools (12). Thus, the lack of sensitive objective examination tools for the early diagnosis of TAO remains an issue.…”

Section: Introductionmentioning

confidence: 99%

Preliminary study of abnormalities in saccade dynamics in patients with hyperthyroidism with no pre‑existing eye damage

Sun

Xie

et al. 2020

Exp Ther Med

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The present study investigated the relationship between hyper thyroidism a nd thyroid-associated ophthalmopathy by examining saccade dynamics to identify defects in eye tracking in patients with hyperthyroidism with no pre-existing eye damage and sensitive indicators that discriminated eye tracking ability in hyperthyroidism. A total of 33 outpatients with hyperthyroidism and 26 healthy controls participated in visually guided saccade (VGS) analysis. Patients with hyperthyroidism were divided into groups based on their medication status (medicated vs. unmedicated). Main sequence analysis was performed to identify differences in peak velocity and duration, and a general linear model (GLM) was used to identify differences in latency, peak acceleration and peak deceleration among the groups. The present study compared differences in the Spearman's correlation coefficient of the duration of saccades and the acceleration asymmetric index (R AD) among the groups. V max values (V max was the asymptotic value of the PV of saccades of large amplitude) were significantly different between the healthy control and unmedicated-hyperthyroidism groups. The results of the GLM-based analysis indicated no significant differences in saccade latency among the three groups. Peak acceleration was significantly different between the healthy control and unmedicated-hyperthyroidism groups (P<0.01). Peak deceleration was significantly different between the healthy control, unmedicated-and medicated-hyperthyroidism groups (P<0.01). R AD was significantly different between the healthy control and medicated-hyperthyroidism groups (P=0.004). The results of the present study suggested that patients with hyperthyroidism with no pre-existing eye damage exhibited significantly altered saccade dynamics during VGS. Therefore, R AD may be used as an indicator to monitor the level of eye movement coordination.

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The Diagnosis and Treatment of Thyroid-Associated Ophthalmopathy

Abstract: Blepharoplasties performed on TAO patients must be undertaken with care and insight to avoid cosmetic and functional complications.

Cited by 21 publications

References 53 publications

Eyelid Surgery in Gravesʼ Orbitopathy

Eyelid Surgery in Gravesʼ Orbitopathy

Utility of T2 mapping in the staging of thyroid-associated ophthalmopathy: efficiency of region of interest selection methods

Preliminary study of abnormalities in saccade dynamics in patients with hyperthyroidism with no pre‑existing eye damage

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