The Increment of Choroidal Thickness in Euthyroid Graves’ Ophthalmopathy: Is It an Early Sign of Venous Congestion?

Abstract

Objective Clinical manifestations of Graves' ophthalmopathy (GO) are caused by the overcompression of orbital tissues within the restricted orbital bone cavity. Impaired ocular blood flow may disrupt the retinal microstructure and functions. In this study, we aimed to investigate the macular and choroidal thickness changes in GO compared with healthy subjects. Materials and Methods The study group comprised 50 adult patients with previously diagnosed Graves' disease with ophthalmopathy who were on antithyroid treatment. For the assessment of GO activity, the VISA (vision, inflammation, strabismus, and appearance) inflammatory score was used. When euthyroidism was achieved without side effects, the patients were referred to the ophthalmology clinic for spectral-domain optical coherence tomography (SD-OCT) evaluation. Results Subfoveal, mean, and temporal choroidal thicknesses were increased significantly in the study group according to the controls. The mean choroidal thickness was elevated. Conclusions This elevation is because of the intraorbital inflammation even in this nonsevere GO group. Choroidal thickness might be affected from the venous obstruction and congestion in patients with GO. The elevation of the choroidal thickness might be an early sign of venous congestion that occurs before the elevation of intraocular pressure.

Choroidal thickness in thyroid‐associated orbitopathy

“…Choroid is the most vascular ocular structure and has been instrumental in the assessment of various ocular diseases . However, information on choroidal changes in TAO is limited . This current study found thicker choroid in patients with TAO compared to healthy subjects over the macula but not the peripapillary regions.…”

“…15 However, information on choroidal changes in TAO is limited. 6,7,16 This current study found thicker choroid in patients with TAO compared to healthy subjects over the macula but not the peripapillary regions. Among TAO eyes, thinner subfoveal choroidal thickness was significantly associated with older age, longer axial length, worse exophthalmos and lower VA. To our knowledge, peripapillary choroidal thickness in TAO patients was reported for the first time.…”

“…Choroidal thickness can be a surrogate imaging marker of orbital congestion in TAO. 16 Although the peripapillary choroidal thicknesses tended to be higher in TAO patients, it was not significantly different compared to controls. Such discrepancy can be attributed to the difference in the choroidal vascular density between the macular and peripapillary regions.…”

“…This suggested that increase in the choroidal thickness may precede any secondary elevation of episcleral venous pressure or IOP. Choroidal thickness can be a surrogate imaging marker of orbital congestion in TAO …”

Evaluation of the Effect of Proptosis on Choroidal Thickness in Graves’ Ophthalmopathy

“…Bruscolini et al 18 also observed higher subfoveal choroidal thickness values in Graves’ ophthalmopathy patients and reported a significant direct correlation between choroidal thickness and CAS score as well as with proptosis level measured by Hertel exophthalmometry. In a similar study, Cagiltay et al 19 included euthyroid patients in the study to eliminate the effect of hyperthyroidism on choroidal circulation and evaluated disease activity with vision, inflammation, strabismus, and appearance (VISA) score. Mean, subfoveal, and temporal choroidal thicknesses were higher in the study group and mean choroidal thickness was positively correlated with VISA score.…”