Thyroid eye disease presenting with superior rectus/levator complex enlargement

Wang, Yao; Mettu, Priyatham S; Broadbent, Talmage; Radke, Phillip M.; Firl, Kevin; Shepherd, James; Couch, Steven M.; Nguyen, Angeline; Henderson, Amanda D.; McCulley, Timothy J.; McClelland, Collin M.; Mokhtarzadeh, Ali; Lee, Michael S.; Garrity, James A.; Harrison, Andrew R.

doi:10.1080/01676830.2019.1594969

Cited by 12 publications

(6 citation statements)

References 4 publications

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“…18 It should be noted that the inferior rectus is the largest muscle at baseline, and while this may contribute to it being the largest muscle measured in TED, recent literature suggests the superior rectus is actually the more affected muscle in TED. [18][19][20] This is supported by the echographic data in the present study. The superior recti remained the largest before and after therapy, followed by inferior recti.…”

Section: Discussionsupporting

confidence: 90%

Echographic Assessment of Extraocular Muscle Response to Teprotumumab

Tran

Pham

Simmons

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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To evaluate extraocular muscle response to teprotumumab using orbital echography in thyroid eye disease.Methods: This retrospective study included adult thyroid eye disease patients with pre-and post-teprotumumab orbital echography. Data collected included: age, Hertel measurements, clinical activity score, Gorman diplopia scores, ocular motility, and recti muscle diameters measured by echography. The patient's more proptotic eye before treatment initiation was designated as the study orbit. Ocular motility was assessed by totaling the ductions in all 4 cardinal directions. Orbital echography was obtained pre-and post-treatment to assess response of extraocular muscle diameters.Results: Six patients with a mean age of 67 years were included. There was a mean improvement in proptosis of 4.3 mm in the study eye with 11/12 orbits showing improvement in globe position (p < 0.05). All patients had a decrease in clinical activity score with a mean reduction of 2.5. Four patients had an improvement in Gorman diplopia score. Ocular motility in the study orbits improved by a total mean of 26.9° (p < 0.05). Mean total extraocular muscle diameter was reduced from 27.4 to 23.4 mm (p < 0.001). On average, superior recti were largest pre-and post-treatment, followed by inferior, medial, then lateral recti. However, inferior recti showed the greatest reduction of 23% (p < 0.02).Conclusions: Orbital echography demonstrated extraocular muscle reduction in all patients after teprotumumab, correlating with improved clinical activity score, ocular motility, and proptosis. Orbital echography is a safe and cost-effective imaging alternative to monitor therapeutic response to teprotumumab.

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Section: Discussionsupporting

confidence: 90%

Echographic Assessment of Extraocular Muscle Response to Teprotumumab

Tran

Pham

Simmons

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…In this study, both drugs showed good therapeutic effects, but results varied in different patients, mainly reflected in the following three points: (1) the principles of the two treatments are different. Wang et al [21] proposed that TAO patients showed enlargement of the superior rectus/levator palpebrae superioris complex, with an average CAS score of 2.1, suggesting that levator palpebrae superioris and superior rectus may be the first muscle tissues to develop lesions in the non-active stage. Byun et al [22] measured the volume of the levator palpebrae complex using imaging methods and also found that upper eyelid retraction was associated with a volume increase.…”

Section: Discussionmentioning

confidence: 99%

Observations on the Efficacy of Two Methods for the Treatment of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy

Sun

2021

BioMed Research International

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Objective. To observe the clinical efficacy of periocular injection of triamcinolone acetonide (TA) and subpalpebral injection of botulinum toxin type A (BTXA) for the treatment of thyroid-associated ophthalmopathy (TAO) with mild unilateral upper eyelid retraction. Method. This was a prospective randomized controlled study. A total of 68 cases of stable thyroid-associated ophthalmopathy with mild upper eyelid retraction were collected at Hankou Aier Eye Hospital from Jan. 2015 to Dec. 2018 and randomly divided into two groups. Group A contained 33 patients who were administered TA by periocular injection once every 3 weeks for a total of 3 times. Group B contained 35 patients who were given a single subpalpebral administration of BTXA. The efficacy in the two groups was observed. Results. Compared with the two groups, the effective rate in both groups was 100% at 1 week and 1 month after treatment. The effective rate of Group A remained 100% at 3 months after treatment, and that of Group B decreased to 88.6%. At 1 week after treatment, the degree of correction in Group B was greater than that in Group A ( p < 0.001 ). At 1 month after treatment, it was not significantly different between the two groups ( p > > > 0.05 ). At 3 months after treatment, it was less in Group B than in Group A ( p < 0.001 ). In Group A, there was one case of transient amaurosis, two cases of periorbital hemorrhage and swelling, and one mild case of sunken eyes. In Group B, four cases experienced recurrence after 3 months. Conclusion. Periocular injection of TA and subpalpebral injection of BTXA offer definite therapeutic efficacy for mild upper eyelid retraction associated with thyroid disease. The former has a long treatment period, large procedural risks, and stable efficacy. The latter is a simple procedure with a short treatment period but can easily recur.

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“…17,18 However, recent literature suggests that although the inferior rectus is often the largest muscle in TED (and also at baseline), the superior rectus may be the more affected muscle in TED and the superior and lateral recti may demonstrate the most severe motility restriction. 5,18,20–22 In the current study, although the inferior and medial recti muscle groups were the largest in size before treatment, the superior and lateral recti muscle groups demonstrated the largest degree of size reduction following treatment.…”

Section: Discussionmentioning

confidence: 48%

Reduction in Extraocular Muscle Cross-sectional Area and Correlation With Extraocular Motility and Diplopia Following Teprotumumab for Thyroid Eye Disease

Reshef

Marsiglia

Bouhadjer

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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To quantify changes in extraocular muscle (EOM) cross-sectional areas (CSA) on orbital imaging in patients with thyroid eye disease before and after teprotumumab treatment, and assess for correlation with clinical outcomes.Methods: This retrospective study included thyroid eye disease patients treated with teprotumumab who had pre-and post-treatment CT imaging. Reformatted oblique coronal images were created for each orbit in a plane perpendicular to the optic nerve. EOM CSA measurements were performed by 2 radiographic reviewers and averaged. Primary outcomes included change in ratio of total EOM to orbit CSA, and of each individual muscle group to orbit CSA, before and after treatment. Secondary outcomes included subanalysis based on age (≥40, <40 years) and Clinical Activity Score (CAS) (≥4, <4), and comparison with clinical outcomes including CAS, Hertel exophthalmometry, Gorman diplopia score, and extraocular motility.Results: Forty-eight orbits of 24 patients (16 female, mean age 57.9 years) were included. There was a significant reduction in the total EOM to orbit CSA ratio (p < 0.01) and for each individual rectus muscle to orbit CSA ratio (p < 0.01 for all groups). Total EOM to orbit CSA ratios were reduced for 21 patients (87.5%); this was statistically significant in 13 patients (54.2%). There was significant improvement in CAS, proptosis, diplopia, and EOM motility (p < 0.01 for all categories). There was a significant correlation between reduction of EOM CSA, and reduction of diplopia (p < 0.01) and EOM motility (p < 0.01).Conclusions: EOM CSA is significantly reduced following treatment with teprotumumab, and correlates with clinical findings including improvement in extraocular motility and diplopia.

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Thyroid eye disease presenting with superior rectus/levator complex enlargement

Cited by 12 publications

References 4 publications

Echographic Assessment of Extraocular Muscle Response to Teprotumumab

Echographic Assessment of Extraocular Muscle Response to Teprotumumab

Observations on the Efficacy of Two Methods for the Treatment of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy

Reduction in Extraocular Muscle Cross-sectional Area and Correlation With Extraocular Motility and Diplopia Following Teprotumumab for Thyroid Eye Disease

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