Preoperative clinical features of reactivated of Graves’ orbitopathy after orbital decompression

Abstract

PurposeTo investigate the incidence and preoperative clinical features of reactivated Graves' orbitopathy (GO) after orbital decompression.MethodsThis study included patients with GO who underwent orbital decompression for disfiguring proptosis and not compressive optic neuropathy and received postoperative follow-up care for more than 12 months. Patients who experienced active inflammatory signs within 6 months of decompression were excluded from analysis. The demographic characteristics, ophthalmic manifestations, and biochemical parameters of the patients were analyzed for association with reactivation of GO by logistic regression analysis.ResultsOut of the 92 patients included in this study, seven (7.6%) experienced reactivation of GO after orbital decompression. The mean time interval between surgery and reactivation of GO was 36.3±14.3 weeks. Univariate logistic regression analysis identified age, existing smoking habits, and modified NOSPECS and Gorman scores as significant factors for the reactivation of GO. The results of multivariate logistic regression analysis revealed that smoking and modified NOSPECS and Gorman scores were associated with the reactivation of GO.ConclusionsQuitting smoking is important for the prevention of reactivation of GO after orbital decompression. Patients with severe symptoms, especially those with restrictive myopathy, should be carefully monitored for reactivation of GO after orbital decompression.

Visual morbidity in thyroid eye disease in Asian Indian patients

“…Passive smoking has also been implicated in severe TED. [ 24 ] However, our case series did not show a correlation between smoking and worsening of eye disease. It is our practice to enquire about tobacco usage habits at the initial visit, and very firmly insist on the patient stopping use of tobacco.…”

Orbital decompression for thyroid eye disease: surgical treatment outcomes in endocrinological assessment

“…There are a few modifications in the NOSPECS classification, in which the ophthalmic parameters used for its assessment are altered, the number of assessed parameters is reduced, or the scoring method is different [22][23][24][25] Jefferis et al discussed the results of the treatment of 55 patients (93 orbits) who underwent orbital decompression. In their studies, they presented data on the mean preoperative CAS, which was 1.4 ± 2.0 points before surgery.…”

“…The greater the number of points in the NOSPECS classification, the more advanced the disease stage. There are a few modifications in the NOSPECS classification, in which the ophthalmic parameters used for its assessment are changed, the number of assessed parameters is reduced, or the scoring method is different [22][23][24][25].…”

The risk factors for Graves’ ophthalmopathy

“…The level of TSHR-Ab in serum which is related to the progression and severity of GO is different between smokers and nonsmokers after 2 and 6 months of radioiodine therapy [16]. Smoking affects the prognosis of GO and shortens the interval between orbital decompression and reactivation [17]. According to clinical practice guidelines, smoking cessation is highly recommended for GO patients [3] (Fig.…”

“…As a critical gene in T cell activation, cytotoxic T-lymphocyte-associated protein 4 (CTLA4) polymorphism plays a role in the pathogenesis of GO. One study detected CTLA-4 g.*642AT (8_33) polymorphism and found that [AT [16][17][18][19][20][21] ] homozygosity increases the risk and the severity of GO, but the [AA] genotype of CTLA-4 g.*6230G > A (rs3087243) has the opposite effect [79]. The frequency of genotype TT in rs733618 of CTLA4 is more common in a control group (OR = 0.421, p = 0.043) and the frequency of genotype CC and CT in rs16840252 of CTLA4 is also different between GO and control groups [80].…”