Free levator complex recession in Graves’ ophthalmopathy Our experience

Uccello, Giovanni; Vassallo, Patricia; Strianese, Diego; Bonavolontà, Giulio

doi:10.3109/01676839409031146

Cited by 8 publications

(2 citation statements)

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“…When TED presents with unilateral proptosis, clinical signs and symptoms such as inflammation, impairment of eye motility and eyelid retraction [22], may be present in the fellow eye, and contralateral proptosis may become clear during the course of the disease [9,12]. Literature on actual unilateral TED is relatively scarce and heterogeneous and there are no conclusive data and explanations for this event.…”

Section: Discussionmentioning

confidence: 99%

Unilateral proptosis in thyroid eye disease with subsequent contralateral involvement: retrospective follow-up study

et al. 2013

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BackgroundThe purpose of this retrospective follow-up study is to evaluate the prevalence of patients with thyroid eye disease presenting with apparent unilateral proptosis and determine the occurrence of exophthalmos in contralateral non-proptotic eye over the time. Associated features with this event were evaluated.MethodsA cohort of 655 consecutive patients affected by thyroid eye disease with a minimum follow-up of 10 years was reviewed. Exophthalmos was assessed by using both Hertel exophthalmometer and computed tomography (CT). The influence of age, gender, hormonal status and of different therapies such as corticosteroids, radiotherapy and surgical decompression on this disease progression was evaluated.ResultsA total of 89 patients (13.5%) (95% confidence interval [CI] 15%-10%) had clinical evidence of unilateral exophthalmos at the first visit. Among these, 13 patients (14%) (95% CI 22%-7%) developed subsequent contralateral exophthalmos. The increase of protrusion ranged from 2 to 7 mm (mean of 4.2). The time of onset varied from 6 months to 7 years (mean time: 29 months). Smoking status, young age and surgical decompression are significantly associated with development of contralateral proptosis (p< .05).ConclusionsAsymmetric thyroid eye disease with the appearance of unilateral exophthalmos at the initial examination is a fairly frequent event, while subsequent contralateral proptosis occurs less commonly. However, physicians should be aware that young patients, particularly if smokers, undergoing orbital decompression in one eye may need further surgery on contralateral side over time.

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Section: Discussionmentioning

confidence: 99%

Unilateral proptosis in thyroid eye disease with subsequent contralateral involvement: retrospective follow-up study

et al. 2013

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“…Treatment options for TED include immunosuppressive agents, radiotherapy, and various surgical procedures such as orbital decompression, squint surgery, and correction of eyelid retraction [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Methotrexate for the Treatment of Thyroid Eye Disease

Strianese

Iuliano

Ferrara

et al. 2014

Journal of Ophthalmology

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Background/Aim. To evaluate the efficacy of methotrexate for the treatment of thyroid eye disease (TED). Methods. 36 consecutive patients with active TED, previously treated with corticosteroids but stopped due to the occurrence of side effects, were commenced on methotrexate therapy. Two different weekly doses were administered depending on the weight of the patient (7.5 mg or 10 mg). Clinical activity score (7-CAS), visual acuity (VA), ocular motility, exophthalmos, and eyelid position were retrospectively evaluated at 3, 6, and 12 months and compared with baseline data. Results. There was a statistically significant improvement in 7-CAS at 3, 6, and 12 months after treatment (P < 0.0001). There was no significant change in visual acuity. Ocular motility disturbances improved at 6 and 12 months (P < 0.001). There was no significant change in exophthalmos (mean 24 mm, SD 3 mm) or eyelid position (marginal reflex distance mean 6 mm, SD 1.5 mm) during the follow-up period. No side effects were registered. Conclusions. Methotrexate therapy is effective in reducing CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. Eventually, it might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids.

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