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Orbit (Amsterdam, Netherlands) Oct 2022To describe the treatment of nine patients with chronic, low clinical activity score thyroid eye disease with teprotumumab.
PURPOSE
To describe the treatment of nine patients with chronic, low clinical activity score thyroid eye disease with teprotumumab.
METHODS
A retrospective series of patients with chronic thyroid eye disease (TED) and low clinical activity score (CAS) treated with teprotumumab infusion therapy. Inclusion criteria: adults over 18 years of age with TED for greater than 9 months and CAS of 1 or less. All patients included in the analyses completed a full series of eight infusions. Primary outcome measures included proptosis and eyelid retraction in both eyes. Secondary outcomes included CAS, reported adverse effects, and surgery post-treatment.
RESULTS
Nine patients met all inclusion criteria, seven females and two males with mean age of 50.2 years and TED diagnosis of 6.25 years. Three patients had a baseline CAS of 1 and 6 had a CAS of 0. Mean proptosis reduction in the worse eye was 4.0 ± 2.4 mm immediately post-treatment ( = .02). Five out of nine patients had extended follow-up (average 16.8 ± 5.1 weeks) with mean proptosis reduction of 4.2 ± 2.8 mm at last follow-up ( = .03). Mean reduction in eyelid retraction in the worse eye was 0.3 ± 1.6 mm post-treatment ( = .58) and 0.5 ± 0.9 mm at last follow-up ( = .30). Three patients reported infusion-related myalgias, two hair thinning, one exacerbated chronic tinnitus, and one hyperglycemia.
CONCLUSIONS
We report clinically and statistically significant proptosis reduction in nine patients with chronic, low CAS TED treated with teprotumumab. Teprotumumab may be an effective treatment option for these patients.
Topics: Adolescent; Adult; Antibodies, Monoclonal, Humanized; Exophthalmos; Eyelid Diseases; Female; Graves Ophthalmopathy; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 34060414
DOI: 10.1080/01676830.2021.1933081 -
Klinische Monatsblatter Fur... Apr 2020Globe luxation due to incarceration of the eyelids behind the globe can occur in patients with proptosis and lax eyelids. It is important to identify this rare event to...
BACKGROUND
Globe luxation due to incarceration of the eyelids behind the globe can occur in patients with proptosis and lax eyelids. It is important to identify this rare event to prevent recurrent episodes with possible serious complications, such as optic neuropathy.
HISTORY AND SIGNS
We present two patients (aged 54 and 83, both male) with recurrent painful globe luxation due to lid incarceration. In the 54-year-old patient, the symptoms occurred in association with exophthalmos in longstanding Graves' disease. The 83-year-old patient presented with physiological protrusion due to adipositas and floppy eyelid syndrome as underlying cause.
THERAPY AND OUTCOME
In both cases, a lateral tarsorrhaphy was performed and further globe luxations with incarcerations of the eyelids and its sequels could be prevented.
CONCLUSION
Globe luxations due to intermittent incarcerations of the eyelids are rare and diagnosis is often missed. It can also be associated with serious sequels and must be recognized and treated early.
Topics: Aged; Aged, 80 and over; Exophthalmos; Eyelid Diseases; Eyelids; Graves Disease; Humans; Male; Middle Aged; Optic Nerve Diseases
PubMed: 32330992
DOI: 10.1055/a-1101-9257 -
Romanian Journal of Ophthalmology 2023Granulomatosis with polyangiitis (GPA) is an autoimmune disorder characterized by necrotizing granulomatous inflammation of small and medium-sized vessels. This... (Review)
Review
Granulomatosis with polyangiitis (GPA) is an autoimmune disorder characterized by necrotizing granulomatous inflammation of small and medium-sized vessels. This systematic review aimed to highlight the most common ophthalmic manifestations and to uncover their associations with antineutrophil cytoplasmic antibody (ANCA) positivity and the presence of granulomas. A literature search of PubMed, Web of Science, and Scopus electronic databases was performed from journal inception to March 21, 2021, for case reports and a series of ophthalmic GPAs. Cytoplasmic-ANCA (c-ANCA), perinuclear-ANCA (p-ANCA), and granulomas were analyzed against many ophthalmic signs and symptoms. 306 patients with GPA were retrospectively studied. Granulomas were present in 47.7% of our sample, c-ANCA in 59.2%, and p-ANCA in 10.8%. Scleritis was significantly associated with higher odds for c-ANCA positivity. Eye discharge, episcleritis, proptosis, and central nervous system (CNS) involvement were each significantly associated with lower odds for c-ANCA positivity. Orbital mass was significantly associated with lower odds for p-ANCA positivity. CNS involvement was significantly associated with higher odds for p-ANCA positivity (OR:3.08, 95% CI:1.02, 9.36, p=0.047) and orbital mass was significantly associated with lower odds for p-ANCA positivity. We recommend that clinicians should consider ocular or orbital GPA in patients presenting with non-specific eye complaints, such as vision impairment, orbital mass, or proptosis, and obtain further assessments to determine the possible presence of granuloma, c-ANCA, or p-ANCA. GPA = Granulomatosis with Polyangiitis, ANCA = antineutrophil cytoplasmic antibody, c-ANCA = cytoplasmic-ANCA, p-ANCA = perinuclear-ANCA, CNS = central nervous system, AAVs = ANCA-associated vasculitides, SD = standard deviation, GU = genitourinary, ENT = ear nose and throat, OR = odds ratio, CI = confidence interval.
Topics: Humans; Granulomatosis with Polyangiitis; Antibodies, Antineutrophil Cytoplasmic; Retrospective Studies; Orbital Diseases; Granuloma; Exophthalmos
PubMed: 37876507
DOI: 10.22336/rjo.2023.38 -
The Journal of Craniofacial Surgery May 2022The extensive bone infiltration and carpet-like growth characteristics of spheno-orbital meningioma (SOM) make it hard to remove entirely, and recurrence and proptosis...
OBJECTIVE
The extensive bone infiltration and carpet-like growth characteristics of spheno-orbital meningioma (SOM) make it hard to remove entirely, and recurrence and proptosis are the main reasons for reoperation. The authors report 20 cases of surgical treatment for recurrence of SOM, including surgical technique and symptom improvement.
METHODS
The clinical data and follow-up results of 20 cases of recurrent SOM at our institution from 2000 to 2017 were retrospectively analyzed.
RESULTS
All of the 20 patients with recurrence had received at least one operation before admission, with a mean age of 56 years and 70% female. The mean follow-up time was 36 months (172 months). All patients mainly showed symptoms such as proptosis and headache, and were found to be affected by supraorbital fissure during the operation. in 17 patients with recurrence, the affected sphenoid wing became tumor-like hyperplasia. Patients with extraocular muscle involvement have obvious protrusion and are often accompanied by diplopia. After surgical removal of the tumor, the symptoms of proptosis in 19 patients were significantly improved. During the follow-up, only 3 cases of proptosis recurred. After 15 patients underwent Simpson grade IV resection, 4 patients (27%) relapsed again. Five patients underwent Simpson III resection, and only 1 patient (20%) had tumor recurrence 18th months after surgery, and no proptosis recurred.
CONCLUSIONS
The complete surgical removal of recurrent SOM is practically impossible. The main direction of surgical treatment should be to improve the symptoms of proptosis.
Topics: Exophthalmos; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Orbital Neoplasms; Retrospective Studies; Sphenoid Bone; Treatment Outcome
PubMed: 34743161
DOI: 10.1097/SCS.0000000000008346 -
Topics in Companion Animal Medicine Sep 2015Orbital diseases are common in dogs and cats and can present on emergency due to the acute onset of many of these issues. The difficulty with diagnosis and therapy of... (Review)
Review
Orbital diseases are common in dogs and cats and can present on emergency due to the acute onset of many of these issues. The difficulty with diagnosis and therapy of orbital disease is that the location of the problem is not readily visible. The focus of this article is on recognizing classical clinical presentations of orbital disease, which are typically exophthalmos, strabismus, enophthalmos, proptosis, or intraconal swelling. After the orbital disease is confirmed, certain characteristics such as pain on opening the mouth, acute vs. chronic swelling, and involvement of nearby structures can be helpful in determining the underlying cause. Abscesses, cellulitis, sialoceles, neoplasia (primary or secondary), foreign bodies, and immune-mediated diseases can all lead to exophthalmos, but it can be difficult to determine the cause of disease without advanced diagnostic imaging, such as ultrasound, magnetic resonance imaging, or computed tomography scan. Fine-needle aspirates and biopsies of the retrobulbar space can also be performed.
Topics: Animals; Cat Diseases; Cats; Diagnosis, Differential; Dog Diseases; Dogs; Emergencies; Exophthalmos; Magnetic Resonance Imaging; Myositis; Orbit; Orbital Diseases; Orbital Neoplasms; Retrobulbar Hemorrhage; Salivary Gland Diseases; Tomography, X-Ray Computed; Ultrasonography
PubMed: 26494502
DOI: 10.1053/j.tcam.2015.07.010 -
Clinical & Experimental Ophthalmology Mar 2021Thyroid eye disease (TED) is a debilitating, vision threatening disease that dramatically alters patients' quality of life. Until recently, the management of TED is a... (Review)
Review
Thyroid eye disease (TED) is a debilitating, vision threatening disease that dramatically alters patients' quality of life. Until recently, the management of TED is a long arduous course with supportive therapy, followed by an extensive surgical treatment plan to reverse the disease endpoints. Teprotumumab offers an early, safe therapeutic intervention to help reverse disease end points such as diplopia and proptosis and improve quality of life.
Topics: Diplopia; Exophthalmos; Graves Ophthalmopathy; Humans; Quality of Life
PubMed: 33484076
DOI: 10.1111/ceo.13899 -
Klinische Monatsblatter Fur... Jan 2017Exophthalmos is a common and important symptom in orbital consultation. It can be either uni- or bilateral. A wide spectrum of benign and malignant diseases has to be... (Review)
Review
Exophthalmos is a common and important symptom in orbital consultation. It can be either uni- or bilateral. A wide spectrum of benign and malignant diseases has to be considered and evaluated for differential diagnosis, in order to maintain complete ocular function and to lead the patient to adequate therapy. Exophthalmos can be accompanied by variable symptoms, ranging from neurogenic or myogenic to corneal alterations. Symptoms at presentation depend on the underlying disease and may manifest systemically. Interdisciplinary teamwork is essential for diagnostics and therapy of exophthalmos. In addition to ophthalmological routine diagnostics, various supplementary examinations are available which are of importance for disease monitoring. Exact radiological imaging is important for the detailed visualisation of the pathology, surgery as well as treatment planning. Magnetic resonance imaging (MRI) and computed tomography (CT) are the standard imaging techniques used. Contrast enhancement and specific sequences can answer specific problems in detail. Combined positron emission tomography (PET) with CT permits evaluation of metabolic and morphological data and is employed in diagnosis of meningioma, lymphoma and metastases. In summary, the reader should learn important differential diagnoses and accompanying symptoms of exophthalmos, thus enabling essential clinical examinations and adequate imaging.
Topics: Corneal Diseases; Diagnosis, Differential; Diagnostic Imaging; Diagnostic Techniques, Ophthalmological; Exophthalmos; Humans
PubMed: 28135745
DOI: 10.1055/s-0042-121809 -
American Journal of Otolaryngology 2022To compare the indications, surgical techniques and outcomes for revision orbital decompression surgery for thyroid eye disease in open, endoscopic, and combined open... (Comparative Study)
Comparative Study
OBJECTIVE
To compare the indications, surgical techniques and outcomes for revision orbital decompression surgery for thyroid eye disease in open, endoscopic, and combined open and endoscopic approaches.
METHODS
A retrospective review of all revision orbital decompression procedures for thyroid eye disease from a single large academic institution over a 17-year period (01/01/2004-01/01/2021) was performed. Patient demographics, as well as indications and types of surgery were reviewed. Outcome measures included changes in proptosis, intraocular pressure, visual acuity and diplopia.
RESULTS
Thirty procedures were performed on 21 patients. There was a median of 9.4 months between primary orbital decompression and revision decompression surgery. There were 6 bilateral procedures, and 2 of these patients underwent additional revision surgeries due to decreased visual acuity with concern for persistent orbital apex compression or sight-threatening ocular surface exposure in the setting of proptosis. Twenty-five procedures were performed as open surgeries with 5 endoscopic/combined cases. Combined Ophthalmology/Otolaryngology surgery via combined open/endoscopic approaches was favoured for persistent orbital apex disease. Visual acuity remained preserved in all patients. The overall median reduction in proptosis was 2 mm and intraocular pressure change was 1 mmHg regardless of surgical approach. The overall rate of new onset diplopia after surgery was 15%. These patients had open approaches. All endoscopic/combined approach patients had pre-existing diplopia. There were no statistically significant differences between the open and endoscopic/combined groups in regard to change in visual acuity, reduction in proptosis or intraocular pressure.
CONCLUSION
Revision orbital decompression is an uncommon procedure indicated for those patients with progressive symptoms despite previous surgery and intensive medical management. Both endoscopic and non-endoscopic techniques offer favourable outcomes with respect to visual acuity, decrease in intraocular pressure, and improvement in proptosis and overall lead to a low incidence of new onset diplopia.
LEVEL OF EVIDENCE
Level IV.
Topics: Aged; Decompression, Surgical; Diplopia; Endoscopy; Exophthalmos; Female; Graves Ophthalmopathy; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Reoperation; Retrospective Studies; Treatment Outcome; Visual Acuity
PubMed: 34487995
DOI: 10.1016/j.amjoto.2021.103196 -
Annals of Emergency Medicine Oct 2023
Topics: Humans; Male; Exophthalmos
PubMed: 37739747
DOI: 10.1016/j.annemergmed.2023.04.023 -
BMJ (Clinical Research Ed.) Mar 2023
Topics: Humans; Exophthalmos
PubMed: 36958736
DOI: 10.1136/bmj-2021-068579