Acute thyroid eye disease (TED): Principles of medical and surgical management

Verity, David H.; Rose, Geoffrey E.

doi:10.1038/eye.2012.284

Cited by 107 publications

(86 citation statements)

References 47 publications

(48 reference statements)

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“…It has been suggested that in GO the success of the immunosuppressive treatment is the result of the effect not only on the autoimmune process but also on the reduction of orbital venous congestion. The impairment of superior orbital vein flow during the inflammatory phase of GO may otherwise persist, despite an effective outcome of immunosuppressive treatment (26). In these patients, ophthalmological signs of the persistent orbital vascular congestion may show similarities with some of those observed in active GO.…”

Section: Chronic Congestive Gomentioning

confidence: 88%

“…In these patients, ophthalmological signs of the persistent orbital vascular congestion may show similarities with some of those observed in active GO. Characteristic diagnostic criteria for the chronic congestive form may be eyelid edema, eyelid and conjunctival redness, chemosis, and caruncle edema associated with disease duration >12 months, orbital CT scan evidence of increased muscle and adipose tissue volume, and unresponsiveness to immnosuppressive therapy (26).…”

Section: Chronic Congestive Gomentioning

confidence: 99%

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THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Campi

Vannucchi

Salvi

2016

European Journal of Endocrinology

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Management of Graves' orbitopathy (GO) must be based on the correct assessment of activity and severity of the disease. Activity is usually assessed with the Clinical Activity Score, whereas severity is classified according to a European Group On Graves' Orbitopathy (EUGOGO) consensus statement as mild, moderate-to-severe, and sight-threatening. Myopathic and chronic congestive forms are uncommon clinical presentations of GO. Restoration and maintenance of stable euthyroidism are recommended in the presence of GO. In moderate-to-severe disease, steroids have been widely employed and have shown to possess an anti-inflammatory activity, but about 20 -30% of patients are not responsive and present recurrence. Some novel immunosuppressors have already been employed in clinical studies and have shown interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the thyroid-stimulating hormone and the insulin-like growth factor 1 receptor on the fibroblasts, inflammatory cytokines, B and T cells, and the PIK3/mTORC1 signaling cascades for adipogenesis. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials. As the main goal of treatment is the well-being of the patient, the therapeutic strategy should be addressed to better suit the patient needs, more than improving one or more biological parameters. The increasing availability of new therapies will expand the therapeutic options for GO patients and allow the clinician to really personalize the treatment to better suit the patients' personal needs.

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Section: Chronic Congestive Gomentioning

confidence: 88%

Section: Chronic Congestive Gomentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Campi

Vannucchi

Salvi

2016

European Journal of Endocrinology

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“…These approaches have been successfully utilized to treat globe malposition. [8][9][10][11][12][13][14][15][16][17][18] Typically, this is performed once the disease state is considered inactive based on serial clinical examinations and monitoring of thyroid-stimulating immunoglobulin (TSI). Orbital decompression can alter axial and vertical globe position, rotation, alignment, and relative relationships to periocular soft tissue structures and thus precedes all other orbital surgical interventions (e.g., strabismus surgery, eyelid retraction repair, blepharoplasty).…”

mentioning

confidence: 99%

Computer-Assisted Three-Dimensional Planning for Orbital Decompression

Mahoney

Grant

Susarla

et al. 2015

Craniomaxillofacial Trauma & Reconstruction

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Thyroid-associated orbitopathy is the most common cause of unilateral or bilateral proptosis in adults. A mainstay of surgical treatment is orbital decompression utilizing osteotomies to increase the size of the affected bony orbit to accommodate the larger soft tissue volume. Over the past several decades, numerous approaches have been described for orbital decompression. However, given the intricate osseous and soft tissue anatomy within the orbit, orbital decompression is a potentially hazardous intervention. With advances in three-dimensional imaging and virtual planning, extensive orbital decompressions can be performed safely and efficiently. In this report, we describe two cases of three-wall orbital decompressions using three-dimensional planning.

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“…Однако остается довольно большая группа пациентов, у которых, не смотря на успешную терапию, сохраняется выра женный одно или двусторонний экзофтальм [1]. Кроме того, в ряде случаев, когда консервативное лечение неэффективно, возможно значительное стойкое снижение зрительных функций в результате поражения роговицы или оптической нейропатии [2]. Все это наряду с нарушениями бинокулярного зрения значительно снижает качество жизни паци ентов.…”

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Transethmoidal decompression of the orbit via external access in combination with resection of its lateral wall in endocrine ophthalmopathy

Кочетков¹,

Grusha²,

Свистушкин³

et al. 2016

Ross. rinol.

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1 ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, Москва, Россия;2 ФГБНУ «Научно-исследовательский институт глазных болезней», Москва, РоссияЦель -представить методику комбинированного подхода к костной декомпрессии орбиты при эндокринной офтальмопатии. Пациенты и методы. Проведен анализ собственных результатов хирургических вмешательств на орбите с резекцией ее костных стенок. Пациентам выполнялись трансэтмоидальная декомпрессия орбиты эндоназальным доступом и резекция латеральной орбитальной стенки наружным доступом. Оба этапа хирургического вмешательства выполнялись одномоментно. В исследование были включены 13 пациентов (21 глаз), из них 12 женщин и 1 мужчина, средний возраст составил 45,5 года. Обследование до и после операции включало стандартное офтальмологическое обследование (наружный осмотр, визометрию, тонометрию, компьютерную периметрию, биомикроскопию, офтальмоскопию), а также использовались дополнительные методы (экзофтальмометрия, орбитометрия, биометрические измерения, фотографирование пациента). Активность эндокринной офтальмопатии оценивали по клинической шкале активности (Clinical Activity Score). Показаниями для операции были оптическая нейропатия и косметически неприемлемый экзофтальм. Проанализированы техника операций, особенности послеоперационного ведения пациентов и результаты лечения. Результаты. Продемонстрирована высокая эффективность комбинированного хирургического подхода к декомпрессивным операциям на орбите в отношении регресса экзофтальма. После сбалансированной костной декомпрессии ни в одном случае не было отмечено снижения остроты зрения, в среднем она составляла 0,97±0,04, разница с предоперационным показателем не была достоверной (p>0,05). Стойкое сходящееся косоглазие и бинокулярное двоение после сбалансированной декомпрессии орбиты, которые требовали в отдаленном периоде хирургического вмешательства на экстраокулярных мышцах, возникли в 4 (19%) случаях. Величина экзофтальма до операции составила 25±2,3 мм (от 21 до 30 мм). В результате сбалансированной декомпрессии орбиты было выявлено достоверное уменьшение экзофтальма в среднем на 4,8 мм (от 4 до 9 мм), его величина в среднем составила 20,2±1,9 мм. Данная методика показала высокую эффективность как в отношении зрительных функций (острота зрения, бинокулярное двоение), так и с точки зрения уменьшения экзофтальма в среднем на 4,8 мм, а послеоперационная диплопия при этом наблюдалась менее чем в 20% случаев. Objective -to present a procedure of a comprehensive approach to bony decompression of the orbit in endocrine ophthalmopathy. Patients and methods. The authors analyzed their results of surgical interventions into the orbit with resection of its bony walls. The patients underwent transethmoidal orbital decompression via endonasal access and resection of the lateral orbital wall via external access. Both stages of the surgical intervention were performed simultaneously. The investigation enrolled 13 patients 21 eyes), including 12 women and 1 man; their mean age wa...

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Acute thyroid eye disease (TED): Principles of medical and surgical management

Abstract: The active inflammatory phase

Cited by 107 publications

References 47 publications

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Computer-Assisted Three-Dimensional Planning for Orbital Decompression

Transethmoidal decompression of the orbit via external access in combination with resection of its lateral wall in endocrine ophthalmopathy

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