Reduction of Orbital Inflammation following Decompression for Thyroid-Related Orbitopathy

Purpose. Thyroid-related orbitopathy (TRO) is associated with inflammation, expansion of orbital fat, enlargement of extraocular muscles, and optic neuropathy (ON). We examined the effects of orbital decompression on the inflammatory and congestive signs of TRO in patients who underwent emergent orbital decompression.Methods. This retrospective, consecutive study included patients with ON from TRO who underwent orbital decompression. Pre- and postoperative orbital inflammatory signs in the operated and nonoperated, contralateral eyes were graded with the 10-item clinical activity score (CAS).Results. Thirty-one orbits were included. Postoperatively, 22 patients and 29 orbits had resolution of ON while the remaining 2 patients had improvement in visual acuity. Mean preoperative CAS was 9.5 ± 0.4. At 12 months, postoperative CAS was 2.1 ± 0.6 (P<0.01) in the operated eye and 3.2 ± 0.5 (P<0.05) in the nonoperated, contralateral eye.Conclusion. In our series, 94% of orbits had resolution of ON. There was also a statistically significant postoperative reduction in the CAS in both the operated and nonoperated, contralateral eyes. This phenomenon may be due to lowered venous congestion, decreased intraorbital pressure, and diminution in inflammatory factors.

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Therapeutic difference between orbital decompression and glucocorticoids administration as the first-line treatment for dysthyroid optic neuropathy: a systematic review

International Journal of Ophthalmology ◽

10.18240/ijo.2021.07.21 ◽

2021 ◽

Vol 14 (7) ◽

pp. 1107-1113

Author(s):

Ming-Na Xu ◽

◽

Yun-Hai Tu ◽

He-Qing Tao ◽

Ke-Si Shi ◽

...

Keyword(s):

Systematic Review ◽

Visual Acuity ◽

Optic Neuropathy ◽

Controlled Trial ◽

Case Series ◽

Cochrane Library ◽

Clinical Activity ◽

High Dose ◽

Orbital Decompression ◽

Dysthyroid Optic Neuropathy

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy (DON). PubMed, EMBASE, the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcomes were the improvement in visual acuity and responder rate. Secondary outcomes were the proptosis reduction, change in diplopia, and clinical activity score (CAS). One randomized controlled trial, three retrospective case series and one prospective case series met the inclusion criteria. They were divided into intravenous high-dose glucocorticoids (ivGC) group and orbital decompression (OD) group. Both groups demonstrated improvement in visual acuity. In addition, the proportion of patients with improved vision in OD group was higher than that in ivGC group (P<0.001). Post-treatment proptosis reduction was also reported in both groups. Overall, weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively. This study also presented results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in 5 included studies. The most common complication in ivGC group and OD group was Cushing’s syndrome and epistaxis respectively. The present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing proptosis. However, high-quality, large-sample, controlled studies need to be performed in the future.

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Choroidal vascularity index in thyroid-associated ophthalmopathy: a cross-sectional study

Eye and Vision ◽

10.1186/s40662-021-00242-6 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Pasquale Loiudice ◽

Marco Pellegrini ◽

Michele Marinò ◽

Barbara Mazzi ◽

Ilaria Ionni ◽

...

Keyword(s):

Cross Sectional Study ◽

Activity Score ◽

Enhanced Depth Imaging ◽

Clinical Activity ◽

Healthy Controls ◽

Cross Sectional ◽

Clinical Activity Score ◽

Significant Difference ◽

Thyroid Associated Ophthalmopathy ◽

Imagej Software

Abstract Background Hemodynamic changes have been observed in patients with Graves’ disease. The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index (CVI) in patients with thyroid-associated ophthalmopathy (TAO). Methods In this cross-sectional observational study, 40 patients affected by TAO were recruited. Forty healthy individuals, matched for age and sex, served as controls. Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants. Images were binarized using the ImageJ software and luminal area (LA) and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. The relation between CVI or subfoveal choroidal thickness (SFCT) and clinical activity score, exophthalmometric value, diplopia status, gender, and age was evaluated. Results CVI was significantly higher in patients with TAO (P = 0.004). No significant difference was observed in SFCT (P = 0.200) and TCA (P = 0.153) comparing TAO patients and healthy controls. LA was significantly higher in TAO group (P = 0.045). On multiple regression analysis, CVI was associated with TCA (P = 0.043). No association was found between SFCT or CVI and TCA, clinical activity score, exophthalmometric value, Inami value, diplopia status, gender or age (P > 0.05). Conclusions This is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.

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Graves’ Orbitopathy: Extraocular Muscle/Total Orbit Area Ratio is Positively Related to the Clinical Activity Score

European Journal of Ophthalmology ◽

10.5301/ejo.5000018 ◽

2011 ◽

Vol 22 (3) ◽

pp. 301-308 ◽

Cited By ~ 12

Author(s):

Rosario Le Moli ◽

Alessandro Pluchino ◽

Vincenzo Muscia ◽

Concetto Regalbuto ◽

Bruno Luciani ◽

...

Keyword(s):

Extraocular Muscle ◽

Area Ratio ◽

Activity Score ◽

Clinical Activity ◽

Clinical Activity Score ◽

Graves Orbitopathy

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A Pilot Study Evaluating 99mTc-anti-TNF-alpha Scintigraphy in Graves' Ophtalmopathy Patients with Different Clinical Activity Score

Hormone and Metabolic Research ◽

10.1055/s-0033-1349891 ◽

2013 ◽

Vol 45 (10) ◽

pp. 765-768 ◽

Cited By ~ 5

Author(s):

E. Rebelo Pinto ◽

F. Lopes ◽

S. de Souza ◽

L. da Fonseca ◽

M. Vaisman ◽

...

Keyword(s):

Pilot Study ◽

Activity Score ◽

Tnf Alpha ◽

Clinical Activity ◽

Clinical Activity Score

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Translation and validation of the Indian Takayasu clinical activity score (ITAS2010) for the Brazilian Portuguese language

Advances in Rheumatology ◽

10.1186/s42358-019-0087-3 ◽

2019 ◽

Vol 59 (1) ◽

Cited By ~ 2

Author(s):

Scheila Fritsch ◽

Rafaela Martinez Copes ◽

Bruna Savioli ◽

Mariana Freitas de Aguiar ◽

Rozana Mesquita Ciconelli ◽

...

Keyword(s):

Clinical Practice ◽

Disease Activity ◽

Correlation Coefficient ◽

Intraclass Correlation ◽

Brazilian Portuguese ◽

Activity Score ◽

Inactive Disease ◽

Clinical Activity ◽

Additional Tool ◽

Clinical Activity Score

Abstract Background The Indian Takayasu Clinical Activity Score (ITAS2010) was developed in 2010 as an assessment tool for disease activity in patients with Takayasu arteritis (TA). It has since been widely used in different studies and in clinical practice for the management of patients with TA. The present study aims to translate the ITAS2010 into Brazilian Portuguese language and to validate it for use in clinical practice in Brazil. Methods For this cross-sectional study, the ITAS2010 was translated in accordance with the guidelines described by Beaton et al. and then applied with 27 patients with TA on three assessments by two rheumatologists working independently. To measure interrater agreement, the assessments were performed on the same day within approximately 1 hour. One of the rheumatologists performed a second evaluation of patients with TA within 7 to 14 days to measure intrarater agreement. Results The correlation coefficient for the ITAS2010 score between the two raters was high (r = 0.916; p < 0.0001), as well as the intraclass correlation coefficient (ICC) [0.918 with a 95% confidence interval (95CI): 0.828–0.962]. The correlation coefficient and the ICC for intrarater agreement were moderate for ITAS2010 (r = 0.633; p < 0.0001 and ICC = 0.594; 95CI: 0.292–0.790). The ITAS2010 at baseline was compared with the physician’s global assessment (PGA) and with Kerr’s criteria for detecting disease activity in TA. Higher ITAS2010 scores were observed in patients with active and grumbling/persistent disease than in those presenting inactive disease according to the PGA [1.5 (0.0–3.0) vs. 0.0 (0.0–0.0); p = 0.0025]. Patients with active disease according to the Kerr’s criteria had also higher ITAS2010 scores than those considered in remission [3.0 (3.0–7.0) vs. 0.0 (0.0–0.0); p = 0.0068]. Conclusions The Brazilian Portuguese version of the ITAS2010 is a valid and reproducible tool for the assessment of disease activity in TA and it is an additional tool for the routine evaluation of Brazilian patients with TA.

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The effects of Rituximab on Graves’orbitopathy: A retrospective study of 14 patients

European Journal of Ophthalmology ◽

10.1177/1120672119845224 ◽

2019 ◽

Vol 30 (5) ◽

pp. 1008-1013 ◽

Cited By ~ 3

Author(s):

Laura Eid ◽

Valentine Coste-Verdier ◽

Eric Longueville ◽

Emmanuel Ribeiro ◽

Bogdan Nicolescu-Catargi ◽

...

Keyword(s):

Adverse Event ◽

Case Series ◽

Activity Score ◽

Clinical Activity ◽

Retrospective Case ◽

Clinical Activity Score ◽

Good Safety Profile ◽

Graves Ophthalmopathy ◽

Long Duration ◽

Duration Of Disease

Purpose: Management of Graves’ ophthalmopathy remains challenging. Over the last decade, previous studies have shown promising results for Rituximab in the treatment of Graves’ ophthalmopathy. We present the response of 14 individuals with active moderate-to-severe Graves’ ophthalmopathy to Rituximab, representing one of the largest retrospective case series reported to date. Methods: Rituximab was administered intravenously, 1000 mg twice at a 2-week interval. The primary end point was a clinical activity score reduction (improvement by ⩾ 2 points or disease inactivation: clinical activity score < 3) at 24 weeks. Secondary end points included clinical activity score improved by ⩾ 2 points or inactivation of Graves’ ophthalmopathy at 12 weeks, improvement in each item of the clinical activity score, in proptosis, in severity disease by the total eye score and in diplopia according to the Gorman score. Results: A limited improvement in clinical activity score was observed (median improvement at 24 weeks by 1 point, p = 0.002, (5/14 patients, 35.7%). Disease inactivation occurred in 50% of patients (7/14 patients). At 12 weeks, clinical activity score improved by ⩾ 2 points in 2/14 patients (14.3%) and inactivation of Graves’ ophthalmopathy occurred in four patients (28.6%). Improvement in proptosis and total eye score was observed in 3/9 patients (33%) and in 4/14 patients (28.6%) at 24 weeks, respectively. Only one patient experienced moderate adverse event. Conclusion: Rituximab is a well-tolerated treatment with a good safety profile, but offered limited and partial improvement for active moderate-to-severe Graves’ ophthalmopathy with a long duration of disease.

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