Evaluation of Ocular Versions in Graves’ Orbitopathy: Correlation between the Qualitative Clinical Method and the Quantitative Photographic Method

Abstract

Purpose. To assess the agreement between the qualitative clinical method and the quantitative photographic method of evaluating normal and abnormal ocular versions in patients with inactive Graves’ orbitopathy (GO). Methods. Forty-two patients with inactive GO had their ocular versions evaluated clinically according to three categories: normal, moderate alterations (−1 or −2 hypofunction), and severe alterations (−3 or −4 hypofunction). The subjects were photographed in the 9 positions of gaze, and the extent (mm) of eye movement in each position was estimated using Photoshop® and ImageJ and converted into degrees with a well-established method. The agreement between the two methods (qualitative vs. quantitative) for classifying ocular versions as normal or abnormal was assessed. Results. The mean quantitative measurements of versions were significantly different for each clinical category (normal, moderate alterations, and severe alterations) in the following five positions: abduction, adduction, elevation in abduction, elevation, and elevation in adduction (p<0.001). No such pattern was observed for the three infraversion positions (depression in abduction, p=0.573; depression, p=0.468; depression in adduction, p=0.268). Conclusion. The agreement was strong between the quantitative photographic method and the qualitative clinical method of classifying ocular versions, especially in lateral and supraversions, which are typically affected in GO. Digital photography is recommended for the assessment of ocular versions due to its practicality, suitability for telemedicine applications, and ease of monitoring during follow-up. This trial is registered with NCT03278964.

Efeito da correção cirúrgica da exoftalmia na motilidade ocular extrínseca de pacientes com orbitopatia de Graves: comparação entre a descompressão orbitária inferomedial e a descompressão orb

“…Na subescala de aparência física houve diferença estatisticamente significativa entre as médias da pontuação entre o pré e o pós-operatório apenas no grupo submetido à DOB, com aumento médio de 20,4 pontos no pós-operatório (DOIM p=0,675; DOB p=0,006). 184 O estudo das versões é parte fundamental da avaliação da motilidade ocular extrínseca, podendo identificar desbalanços sutis que poderiam passar despercebidos somente com a avaliação das duções e auxiliando no diagnóstico e tratamento de estrabismos incomitantes, restritivos e paralíticos. 42,43 A avaliação das versões durante o exame da motilidade ocular extrínseca conta com vários métodos publicados, [48][49][50][164][165][166][167] com poucos estudos que tenham comparado as diferentes metodologias.…”

“…Comparação da pontuação do GO-QoL no pré-operatório e após 6 meses da descompressão orbitária em uma amostra de 42 pacientes com orbitopatia de Graves Os resultados dessa tese foram objeto de duas publicações. O primeiro trabalho184 (Apêndice 1) avaliou se havia concordância entre dois métodos de…”