Predictive factors of prognosis after radiation and steroid pulse therapy in thyroid eye disease

Ito, Makoto; Takahashi, Yasuhiro; Katsuda, Eisuke; Oshima, Yukihiko; Takeuchi, Arisa; Mori, Toshitaka; Abe, Souichirou; Mori, Yoshimasa; Kakizaki, Hirohiko; Suzuki, Kôjiro

doi:10.1038/s41598-019-38640-5

Cited by 14 publications

(23 citation statements)

References 20 publications

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“…None of the patients underwent orbital radiotherapy. This is used for active TED to reduce inflammation and to prevent recurrence of active TED [26,27]. However, as chronic dry eye occasionally occurs after radiotherapy [28], MGD and SLK may be refractory after orbital decompression in such patients.…”

Section: Discussionmentioning

confidence: 99%

Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease

Takahashi

Vaidya

Kakizaki

2021

JCM

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The aim of this prospective observational study was to examine changes in eyelid pressure and dry eye status after orbital decompression in thyroid eye disease (TED). In 16 patients (29 sides), upper eyelid pressure at plateau phase and maximum pressure were measured. TED status was evaluated through the Hertel exophthalmometric value and margin reflex distance (MRD)-1 and 2. Dry eye status was quantified through corneal fluorescein staining, tear break-up time, Schirmer test I results, meibomian gland dysfunction (MGD), tear meniscus height, and superior limbic keratoconjunctivitis (SLK). Patients were classified into two groups: patients with decreased eyelid pressure (Group 1) and those with elevated pressure (Group 2). Consequently, neither the maximum upper eyelid pressure nor pressure at plateau phase significantly changed after surgery (p > 0.050). Some parameters about MGD improved after surgery, but the other parameters on dry eye, MGD, and SLK worsened or did not change. MRD-1 decreased more (p = 0.028), and the ratio of patients in whom SLK improved after surgery was larger in Group 1 (p = 0.030). These results indicate that upper eyelid pressure tends to decrease postoperatively in patients with a high upper eyelid position, resulting in improvement of SLK.

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Section: Discussionmentioning

confidence: 99%

Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease

Takahashi

Vaidya

Kakizaki

2021

JCM

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“…However, they could not provide objective and quantifiable evidence ( 8 ). Recently, two studies reported that responsive TAO patients had a lower standard deviation of signal intensity at EOM on T2-weighted image, which reflected that the EOM signal was more uniform in responsive patients than unresponsive mimics ( 24 , 25 ). TAO usually involves a transition from an active phase to a stationary phase, and the progression of fibrosis is often accompanied by an increase in the heterogeneity of the affected regions ( 8 , 26 , 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

Texture analysis of orbital magnetic resonance imaging for monitoring and predicting treatment response to glucocorticoids in patients with thyroid-associated ophthalmopathy

Wang

Chen

et al. 2021

Endocrine Connections

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Purpose: To evaluate the value of magnetic resonance imaging (MRI)-based texture analysis of extraocular muscle (EOM) and orbital fat (OF) in monitoring and predicting the response to glucocorticoid (GC) therapy in patients with thyroid-associated ophthalmopathy (TAO). Methods: Thirty-seven active and moderate-to-severe TAO patients (responders, n=23; unresponders, n=14) were retrospectively enrolled. MRI-based texture parameters (entropy, uniformity, skewness and kurtosis) of EOM and OF were measured before and after GC therapy, and compared between groups. Correlations between the changes of clinical activity score (CAS) and imaging parameters before and after treatment were assessed. Receiver operating characteristic curves were used to evaluate the predictive value of identified variables. Results: Responsive TAOs showed significantly decreased entropy and increased uniformity at EOM and OF after GC therapy (p<0.01), while unresponders showed no significance. Changes of entropy and uniformity at EOM and OF were significantly correlated with changes of CAS before and after treatment (p<0.05). Responders showed significantly lower entropy and higher uniformity at EOM than unresponders before treatment (p<0.01). Entropy and uniformity of EOM and disease duration were identified as independent predictors for responsive TAOs. Combination of all three variables demonstrated optimal efficiency (area under curve, 0.802) and sensitivity (82.6%), and disease duration alone demonstrated optimal specificity (100%) for predicting responsive TAOs. Conclusion: MRI-based texture analysis can reflect histopathological heterogeneity of orbital tissues. It could be useful for monitoring and predicting the response to GC in TAO patients.

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“…60 In contrast, Japanese physicians prefer IV over oral steroids as first-line therapy. 9 , 61 ASOPRS members also chose orbital decompression (83%), RT (70%), biologic agents (33%), and intra-orbital local steroid injections (28%). The treatment of sight-threatening GO could consist of a combination of these treatments, including urgent orbital decompression.…”

Section: Treatment Options For Don: Overviewmentioning

confidence: 99%

Insights into Current Management Strategies for Dysthyroid Optic Neuropathy: A Review

Tagami¹,

Honda²,

Azumi³

2022

OPTH

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Dysthyroid optic neuropathy (DON) is a potentially sight-threatening eye disease associated with Graves’ orbitopathy (GO). DON is not common in GO patients, reportedly occurring in only about 5% of patients. The pathogenesis of severe DON is considered to involve both muscular nerve strangulation and impaired blood flow. There is some objective grading of physical examination findings and the severity of GO, including a clinical activity score (CAS) and EUropean Group On Graves’ Orbitopathy (EUGOGO), but no specialized protocol completely characterizes DON. Most clinicians have decided that the combination of clinical activity findings, including visual acuity, color vision, and central critical fusion frequency, and radiological findings, including magnetic resonance imaging (MRI), can be used to diagnose DON. MRI has the most useful findings, with T2-weighted and fat-suppressed images using short-tau inversion recovery (STIR) sequences enabling detection of extraocular changes including muscle and/orbital fat tissue swelling and inflammation and, therefore, disease activity. The first-choice treatment for DON is intravenous administration of steroids, with or without radiotherapy. Unfortunately, refractoriness to this medical treatment may indicate the need for immediate orbital decompression within 2 weeks. Especially in the acute phase of DON, thyroid function is often unstable, and the surgeon must always assume the risk of general anesthesia and intra- and post-operative management. In addition, there are currently many possible therapeutic options, including molecular-targeted drugs. The early introduction and combination of these immunomodulators, including Janus kinase inhibitors and insulin-like growth factor-1 receptor antibody (teprotumumab), may be effective for GO with DON. However, this is still under investigation, and the number of case reports is small. It is possible that these options could reduce systemic adverse events due to unfocused glucocorticoid administration. The pathophysiology of DON is not yet fully understood, and further studies of its treatment and long-term visual function prognosis are needed.

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Predictive factors of prognosis after radiation and steroid pulse therapy in thyroid eye disease

Cited by 14 publications

References 20 publications

Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease

Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease

Texture analysis of orbital magnetic resonance imaging for monitoring and predicting treatment response to glucocorticoids in patients with thyroid-associated ophthalmopathy

Insights into Current Management Strategies for Dysthyroid Optic Neuropathy: A Review

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