Evaluation of Meibomian Gland Loss and Ocular Surface Changes in Patients with Mild and Moderate-to-Severe Graves’ Ophthalmopathy

Tuğan, Büşra Yılmaz; Özkan, Berna

doi:10.1080/08820538.2021.1937662

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…The results of the current study are in line with the meibomian gland dropout that was observed in previous reports using both slit-lamp examination and noncontact meibography. 15–20 Furthermore, upper eyelid MGDA and meibography sore were found to be correlated with Hertel measurements. Studies in the literature evaluating the possible correlation of Hertel measurement with noncontact meibography parameters yielded different results.…”

Section: Discussionmentioning

confidence: 85%

“…Patients with GO have been shown to have a higher prevalence of obstructive meibomian gland disease than healthy controls. [15][16][17][18][19][20] Taking in account different pathogenetic mechanisms that underlie dry eye disease in GO patients, focusing on the impact of meibomian gland loss on the corneal nerves could provide clinically useful view in dry eye disease state. To the best of our knowledge, no research has been conducted to evaluate the possible relationship between the degree of meibomian gland loss and the density of the corneal subbasal nerve plexus in GO to date.…”

mentioning

confidence: 99%

“…Upper and lower eyelid meibography scores and total meibography score were obtained by summation of upper and lower eyelid meibography scores and also MGDA for upper and lower eyelid were obtained differentially. 15 In Vivo Confocal Microscopy of Corneal Subbasal Nerve Plexus. The Heidelberg Retina Tomograph (HRT3) configured with a Rostock Corneal Module (Heidelberg Engineering GmbH, Heidelberg, Germany) was used to conduct in vivo confocal microscopy (IVCM) on the OD of all participants by single experienced operator (R.Y.)…”

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confidence: 99%

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Is Corneal Subbasal Nerve Loss Associated With Meibomian Gland Loss in Inactive Mild and Moderate-to-Severe Graves’ Ophthalmopathy?

Tuğan

Özkan

Yüksel

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To evaluate meibomian gland and subbasal nerve plexus parameters in Graves’ Ophthalmopathy (GO) and association of meibomian gland loss with corneal subbasal nerve plexus loss. Methods: Fifty-two eyes of 52 mild and moderate-to-severe GO patients and 32 eyes of 32 healthy controls were enrolled. The meibomian gland dropout area (MGDA) and meibography scores were evaluated using noncontact meibography. In vivo confocal microscopy of corneal subbasal nerve plexus were conducted. ACCMetrics was used to obtain corneal parameters. Results: Compared with healthy subjects, GO patients had worse upper and lower eyelid MGDA (p < 0.001, for all) and upper, lower and total meibography scores (p < 0.001, p = 0.001, and p < 0.001, respectively). Eyelid margin scores were worse in the GO group (p < 0.001) and showed correlation with all noncontact meibography parameters (p < 0.001 for all). All corneal subbasal nerve parameters were significantly lower in the GO group compared with the controls (p < 0.05 for all). Subbasal nerve parameters of GO patients did not reveal a correlation with MGDA and meibography scores but showed correlations with ocular surface disease index score and Schirmer I test (r = –0.304; p = 0.042 and r = 0.336; p = 0.021, respectively). Conclusion: Meibomian gland and corneal nerve loss could be observed even in the inactive phase and mild GO. The lack of a correlation between meibomian gland loss and subbasal nerve loss suggests that meibomian gland loss is not a significant additional component in the pathogenesis of subbasal nerve damage in GO. Furthermore, our study revealed new evidence regarding the use of eyelid margin score to represent meibomian gland loss in GO.

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Section: Discussionmentioning

confidence: 85%

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confidence: 99%

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confidence: 99%

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Is Corneal Subbasal Nerve Loss Associated With Meibomian Gland Loss in Inactive Mild and Moderate-to-Severe Graves’ Ophthalmopathy?

Tuğan

Özkan

Yüksel

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…The CAS system was used to assess activity of TAO, and was made up of 7 components: spontaneous retrobulbar pain, pain on attempted upward or downward gaze, redness of eyelids, redness of conjunctiva, swelling of caruncle or plica, swelling of eyelids, and swelling of conjunctiva. Each component was evaluated as present or absent (scored as 1 or 0, respectively) and the sum of component scores was categorized as inactive stage (0-2) or active inflammation stage (3)(4)(5)(6)(7). The Ocular Surface Disease Index (Allergan, Inc), 19 a questionnaire consisting of 12 questions to evaluate dry eye symptoms, was administered.…”

Section: Methodsmentioning

confidence: 99%

“…2 Patients with mild TAO often experience severe cosmetic disfigurement, photophobia, tearing, and blurred vision, negatively impacting physical and psychological health. 1, [3][4][5] In 1 study of mild TAO with a median follow-up of 12 months, 38 patients (64%) had persistent eye discomfort, and the condition of the remaining 8 patients (14%) deteriorated. 6 Early intervention from endocrinologists and ophthalmologists is advised to alleviate mild TAO-associated signs and symptoms, and to prevent deterioration to moderate-severe TAO or even blindness.…”

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Doxycycline vs Placebo at 12 Weeks in Patients With Mild Thyroid-Associated Ophthalmopathy

et al. 2022

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ImportanceMild thyroid-associated ophthalmopathy (TAO) negatively impacts quality of life, yet no clinical guidelines for its treatment are available. Existing evidence supports the use of doxycycline in treating mild TAO.ObjectiveTo evaluate the short-term (12 weeks) efficacy of doxycycline in treating mild TAO.Design, Setting, and ParticipantsIn this placebo-controlled multicenter randomized double-masked trial, 148 patients were assessed for eligibility. After exclusions (patients who were pregnant or lactating, had an allergy to tetracyclines, or had uncontrolled systematic diseases), 100 patients with mild TAO (orbital soft tissue affected mildly) at 5 centers in China were enrolled from July 2013 to December 2019 and monitored for 12 weeks.InterventionsParticipants were randomly assigned 1:1 to receive doxycycline (50 mg) or placebo once daily for 12 weeks.Main Outcomes and MeasuresThe primary outcome was the rate of improvement at 12 weeks compared with baseline assessed by a composite indicator of eyelid aperture (reduction ≥2 mm), proptosis (reduction ≥2 mm), ocular motility (increase ≥8°), and Graves ophthalmopathy-specific quality-of-life (GO-QOL) scale score (increase ≥6 points). Adverse events were recorded.ResultsA total of 50 participants were assigned to doxycycline and 50 to placebo. The mean (SD) age was 36.7 (9.1) years; 75 participants (75.0%) were female and 100 (100.0%) were Asian. Medication compliance was checked during participant interviews and by counting excess tablets. At week 12, the improvement rate was 38.0% (19 of 50) in the doxycycline group and 16.0% (8 of 50) in the placebo group (difference, 22.0%; 95% CI, 5.0-39.0; P = .01) in the intention-to-treat population. The per-protocol sensitivity analysis showed similar results (39.6% [19 of 48] vs 16.0% [8 of 50]; difference, 23.6%; 95% CI, 6.4-40.8; P = .009). No adverse events other than 1 case of mild gastric acid regurgitation was recorded in either group.Conclusions and RelevanceThe results of this study indicate that oral doxycycline, 50 mg daily, resulted in greater improvement of TAO-related symptoms at 12 weeks compared with placebo in patients with mild TAO. These findings support the consideration of doxycycline for mild TAO but should be tempered by recognizing the relatively short follow-up and the size of the cohort.Trial RegistrationClinicalTrials.gov Identifier: NCT02203682

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Ocular surface disease in thyroid eye disease: A narrative review

et al. 2022

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Evaluation of Meibomian Gland Loss and Ocular Surface Changes in Patients with Mild and Moderate-to-Severe Graves’ Ophthalmopathy

Cited by 7 publications

References 29 publications

Is Corneal Subbasal Nerve Loss Associated With Meibomian Gland Loss in Inactive Mild and Moderate-to-Severe Graves’ Ophthalmopathy?

Is Corneal Subbasal Nerve Loss Associated With Meibomian Gland Loss in Inactive Mild and Moderate-to-Severe Graves’ Ophthalmopathy?

Doxycycline vs Placebo at 12 Weeks in Patients With Mild Thyroid-Associated Ophthalmopathy

Ocular surface disease in thyroid eye disease: A narrative review

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