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      Preoperative clinical features of reactivated of Graves' orbitopathy after orbital decompression

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      Author(s): 1 , 1 , 1 , *
      Publication date (Electronic):
      Journal: Eye
      Publisher: Nature Publishing Group

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          Abstract

          Purpose

          To investigate the incidence and preoperative clinical features of reactivated Graves' orbitopathy (GO) after orbital decompression.

          Methods

          This study included patients with GO who underwent orbital decompression for disfiguring proptosis and not compressive optic neuropathy and received postoperative follow-up care for more than 12 months. Patients who experienced active inflammatory signs within 6 months of decompression were excluded from analysis. The demographic characteristics, ophthalmic manifestations, and biochemical parameters of the patients were analyzed for association with reactivation of GO by logistic regression analysis.

          Results

          Out of the 92 patients included in this study, seven (7.6%) experienced reactivation of GO after orbital decompression. The mean time interval between surgery and reactivation of GO was 36.3±14.3 weeks. Univariate logistic regression analysis identified age, existing smoking habits, and modified NOSPECS and Gorman scores as significant factors for the reactivation of GO. The results of multivariate logistic regression analysis revealed that smoking and modified NOSPECS and Gorman scores were associated with the reactivation of GO.

          Conclusions

          Quitting smoking is important for the prevention of reactivation of GO after orbital decompression. Patients with severe symptoms, especially those with restrictive myopathy, should be carefully monitored for reactivation of GO after orbital decompression.

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          Most cited references26

          • Record: found
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          Graves' ophthalmopathy.

          Rebecca Bahn (2010)
          Article 0 comments Cited 416 times – based on 0 reviews     Review now
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            Thyrotropin receptor autoantibodies are independent risk factors for Graves' ophthalmopathy and help to predict severity and outcome of the disease.

            Marco Plicht, Sebastian Lederbogen, Nils Morgenthaler … (2006)
            The objective of this study was to examine whether TSH-receptor antibody [TSH binding inhibitory antibodies (TBII)] levels are associated with the severity of Graves' ophthalmopathy (GO) over the entire course of the disease. A total of 159 patients with GO were followed for 12-24 months. One year after the first symptoms of GO, all patients were classified into mild or severe GO according to their clinical manifestations. TBII were measured every 3 months after onset of GO. Receiver operating characteristic plot analysis was performed to assess the power to discriminate both patient groups by TBII (specificity >90%). TBII levels and prevalence at each time point during follow-up were significantly higher in patients with a severe course of GO compared with patients with a mild course of GO. Prognostic statements on the course of the disease were possible for about half of the GO patients at all time points (except the first). If at first presentation and at consecutive time points TBII levels were less than 5.7, 2.6, 1.5, 1.5, 1.5, and 1.5 IU/liter, the patients had a 2.3- to 15.6-fold higher chance of a mild course. If 5-8 months after GO onset and at consecutive time points TBII levels were above 8.8, 5.1, 4.8, 2.8, and 2.8 IU/liter, the patients had a 8.7- to 31.1-fold higher risk of a severe course. This relationship of TBII to the severity was independent from age and smoking. Follow-up measurements of TBII allow, in half of the patients, assessment of the prognosis of GO and, therefore, could be of additional help for the disease management.
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              Epidemiology and prevention of Graves' ophthalmopathy.

              W. Wiersinga, Luigi Bartalena (2002)
              Graves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%-5% of patients. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is more frequent in women than in men, although the female-to-male ratio is only 1:4 in severe forms of eye disease. The natural history of Graves' ophthalmopathy is incompletely defined, but in many instances, especially in mild forms, the disease may remit or improve spontaneously. The onset of the ophthalmopathy is in most cases concomitant with the onset of hyperthyroidism, but eye disease may precede or follow hyperthyroidism. Cigarette smoking plays an important role in the occurrence of the ophthalmopathy, and is also associated with a higher degree of disease severity and a lower effectiveness of its medical treatment. Primary prevention (i.e., avoidance of the occurrence of the ophthalmopathy) is presently not feasible, but smoking withdrawal in relatives of patients with Graves' disease might be important. In terms of secondary prevention (i.e., avoidance of progression of subclinical eye disease into overt and severe ophthalmopathy) in addition to refraining from smoking, early and accurate control of thyroid dysfunction (both hyperthyroidism and hypothyroidism), as well as early diagnosis and treatment of mild eye disease are important. As to the role that management of hyperthyroidism may play in the course of Graves' ophthalmopathy, while antithyroid drugs and thyroidectomy are not disease-modifying treatments, radioiodine therapy causes a progression of the ophthalmopathy in approximately 15% of patients, especially high-risk patients, who smoke, have severe hyperthyroidism or uncontrolled hypothyroidism, high levels of thyrotropin (TSH)-receptor antibody, or preexisting eye disease. However, the risk of radioiodine-associated progression of the opthalmopathy can be eliminated by concomitant treatment with middle-dose glucocorticoids. In terms of tertiary prevention (i.e., avoidance of deterioration and complications of overt disease) early immunosuppressive treatment or orbital decompression, as appropriate, are essential tools. Smoking withdrawal may increase the effectiveness of immunosuppressive treatment.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eye (Lond)
                Journal ID (iso-abbrev): Eye (Lond)
                Title: Eye
                Publisher: Nature Publishing Group
                ISSN (Print): 0950-222X
                ISSN (Electronic): 1476-5454
                Publication date (Print): April 2017
                Publication date (Electronic): 06 January 2017
                Volume: 31
                Issue: 4
                Pages: 643-649
                Affiliations
                [1 ] Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine , Seoul, South Korea
                Author notes
                [* ] Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine , 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea Tel: +82 2 2228 3570; Fax: +82 2 312 0541. E-mail: yoonjs@ 123456yuhs.ac
                Article
                Accession ID: PMC5396009 Pmcid ID: PMC5396009 Pmc-uid ID: 5396009 Publisher Item ID: eye2016304
                DOI: 10.1038/eye.2016.304
                PMC ID: 5396009
                PubMed ID: 28060361
                SO-VID: 0d7f9a30-e9fc-49e6-90c8-d6605e0bc02b
                Copyright © Copyright © 2017 Royal College of Ophthalmologists Macmillan Publishers Limited, part of Springer Nature.
                History
                Date received : 18 July 2016
                Date accepted : 20 November 2016
                Categories
                Subject: Clinical Study

                Data availability:

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