Clinical Activity Score Research Articles

Temporal trends in the clinical presentation of Graves’ orbitopathy: a single–center retrospective study

PurposeGraves’ ophthalmopathy (GO) is an autoimmune disease that affects orbital soft tissues and represents the most common extrathyroidal manifestation of Graves’ disease (GD). The European Group of Graves’ Ophthalmopathy (EUGOGO) has attempted to shed light on the European epidemiological picture of GO, suggesting that GO in newly diagnosed patients in recent years has a trend towards a less severe clinical presentation. There are no studies that focus this issue on the population of our area; we aimed to evaluate the trend of GO clinical presentation in our outpatient clinic through an observation period of 10 years.MethodsWe compared 55 consecutive patients, 11 males (F) and 44 females (M), who came to our observation from January 2005 to December 2006 [Group 1 (G1)], with 56 patients, 15 males, and 41 females, who were referred to us from 2015 to 2016 [Group 2 (G2)]. We studied the following putative predictors of GO presentation and severity: thyroid function, smoking, diabetes, hypercholesterolemia, time from GO diagnosis to referral to our thyroid centre (TGOD), sex and age.ResultsGO severity was significantly reduced in G2 vs. G1 (p = 0.04). TGOD ≥ 3 months was related to clinical characteristics of GO (severity and Clinical Activity Score ≥ 4) and was an independent predictor of GO severity (p = 0.01). The other variables evaluated had no independent effects.ConclusionsWe found that GO severity at presentation was significantly reduced over a ten-year observation period (2005–2006 vs. 2015–2016) in GO patients referred to our tertiary thyroid centre. TGOD ≥ 3 months was an independent predictor of GO severity.

Thyroid Eye Disease: Pilot Study Comparison Between Patients in United States-Based and India-Based Practices

PurposeThyroid eye disease (TED) phenotype varies by ethnicity/race and genetic/environmental factors. This study compared demographic and clinical characteristics of TED patients from the US and India. DesignObservational pilot study Methods64 patients with TED ages ≥18 years old with active disease (onset of symptoms ≤18 months or presenting clinical activity score (CAS) ≥4) were recruited between March and October 2021 from clinical practices in the United States (Philadelphia, PA) (n= 30) and India (Hyderabad, India) (n=34). Data collection at baseline and 3 months included clinical measurements, thyroid disease history, and photographs. Ocular symptoms and quality of life data were obtained by phone interview. CAS was calculated using the standard 7-point scale. ResultsThere was no statistically significant difference in age, TED duration, or smoking status between patient groups. Both groups had good vision, a low rate of optic neuropathy, and comparable exophthalmometry. US patients were predominantly female (86.7% (26/30)), with a history of hyperthyroidism (96% 29/30). In comparison, Indian patients were 52.9% (18/34, p=0.004) female; underlying thyroid disease was distributed between hyperthyroidism (52%), hypothyroidism (17.6%) and euthyroid (9.7%). Mean (SD) CAS in the US cohort was double the score in the India cohort (4.2 (1.7) vs 1.65 (1.7), respectively) (P<0.0001). However, patients at both sites experienced subjective symptoms of TED at a similar frequency. ConclusionsObserved differences in TED between US and Indian patients warrant further investigation to elucidate differences in pathogenesis, disease expression, or other factors that may influence TED in diverse populations.

Significant Role of Thyroid Stimulating Hormone in the Clinical Activity Score of Thyroid Eye Disease at a Tertiary Hospital in Surabaya, Indonesia

Highlights:1. This study, conducted at a tertiary hospital, was the first to analyze the correlation between thyroid status and clinical activity score in thyroid eye disease.2. This study offers valuable information regarding the crucial role of thyroid stimulating hormone (TSH) in determining the clinical activity score of thyroid eye disease. Abstract Thyroid eye disease is an autoimmune disorder characterized by inflammation of the orbital and periorbital tissues. This condition can lead to vision impairment, which is a notable manifestation of thyroid disease. The symptoms of thyroid disease reflected the level of inflammatory activity, whereas the clinical activity score was indicative of active and inactive phases. This retrospective analysis explored the intricate association between thyroid status and clinical activity score in thyroid eye disease patients, with the hope of providing a foundation for further research on the association between thyroid status and the occurrence of TED. This study utilized medical records from the years 2019 to 2022 from the Outpatient Department of Ophthalmic Oncology of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The variables examined in this study were thyroid status and the clinical activity score of thyroid eye disease. The statistical analysis was performed using Phi and Cramer’s V as well as Spearman's correlation test (p&lt;0.05). A total of 88 patients were diagnosed with thyroid eye disease during the study period. Thyroid eye disease primarily affected female patients (58%) and those who had a mean age of ≥41 years (58%). The Phi and Cramer’s V analyses indicated no significant association (p &gt; 0.05) between thyroid status and clinical activity score in thyroid eye disease patients. Intriguingly, the results exhibited the presence of euthyroidism as well as both overt and subclinical hypothyroidism and hyperthyroidism, regardless of the clinical activity score. Additionally, the Spearman test that incorporated the levels of thyroid hormones, i.e., triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), and free thyroxine (FT4), showed a significant negative correlation (p&lt;0.05) between TSH and clinical activity score. In conclusion, THS plays a crucial role in determining the clinical activity score of thyroid eye disease patients. This study underscores the imperative for further research to comprehensively elucidate the intricate correlation between TSH and clinical activity score.

Investigation of lacrimal gland and extraocular muscle in thyroid eye disease patients with severe subjective dry eye disease: a multiparametric magnetic resonance imaging study

PurposeTo analyze the radiological features of the lacrimal gland (LG) and extraocular muscle (EOM) in thyroid eye disease (TED) patients with severe subjective dry eye disease (DED) using magnetic resonance imaging (MRI) measurements.MethodsIn this cross-sectional study, mechanical ocular exposure, dry eye assessment and MRI data were collected. Patients were classified into non-severe subjective DED group with ocular surface disease index (OSDI) < 33 and severe subjective DED group with OSDI ≥ 33. Linear regression model was applied for comparing the OSDI < 33 and OSDI ≥ 33 group in TED patients. The predictive performance of MRI parameters and models was assessed by receiver operating characteristic curve (ROC) analysis.ResultsConsecutive 88 TED patients (176 eyes) were included in this study. In the OSDI < 33 group, 52 TED patients (104 eyes) with a mean clinical activity score (CAS) of 0.63 ± 0.75. In the OSDI ≥ 33 group, there are 36 TED patients (72 eyes), with a mean CAS of 1.50 ± 1.54. The age and sex of the patients were matched between the two groups. The OSDI ≥ 33 group had shorter tear break-up time, larger levator palpebrae superioris / superior rectus (LPS/SR), inferior rectus and lateral rectus, smaller LG, more inflammatory LPS/SR and inferior rectus than OSDI < 33 DED group (P < 0.05). In the linear regression analysis, compare to the OSDI < 33 DED group, the OSDI ≥ 33 group had larger medial rectus cross-sectional area (β = 0.06, 95%CI: (0.02, 0.10), P = 0.008), larger inferior rectus cross-sectional area (β = 0.06, 95%CI: (0.00, 0.12), P = 0.048), smaller LG cross-sectional area (β = -0.14, 95%CI: (-0.25, -0.04), P = 0.008). In the ROC analysis, the area under curve of medial rectus, inferior rectus, LG, and combined model are 0.625, 0.640, 0.661 and 0.716, respectively.ConclusionMultiparametric MRI parameters of the LG and EOM in TED patients with severe subjective DED were significantly altered. Novel models combining the cross-sectional area of LG, medial rectus and inferior rectus showed good predictive performance in TED patients with severe subjective DED.

Correlation of clinical and radiological scores for evaluation of activity in patients having thyroid-associated orbitopathy: A prospective observational study.

To find a correlation between the clinical (vision-inflammation-strabismus-appearance [VISA] score) and radiological (apparent diffusion coefficient [ADC] values) scores for evaluating disease activity in patients with thyroid-associated orbitopathy. A prospective comparative study. Our study was performed for consecutively diagnosed thyroid-associated orbitopathy (TAO) patients. Clinical evaluation included the VISA classification system with the basic thyroid workup. An inflammatory score of <4/8 was considered inactive and ≥4/8 as an active disease. Every included patient underwent a diffusion-weighted magnetic resonance imaging (DW-MRI) scan of the orbits. The orbital parameters evaluated on imaging included the proptosis, thickness, as well as the ADC values of extraocular muscles. We studied 33 consecutive patients (23 females, 69.7%) with a mean age of 41.8 years. The majority (n = 27, 81.8%) were hyperthyroid, four were hypothyroid, and two were euthyroid. In the VISA classification, nine patients had active TAO (≥4/8 inflammation score), while 24 had inactive disease. There was a positive correlation between the inflammation score and ADC values of medial rectus (MR), inferior rectus (IR) and lateral rectus (LR). We had nine patients with inflammation scores ≥4. With receiver operating characteristic (ROC) curve analysis, we found that the ADC value of IR can predict disease activity with 68% sensitivity and MR-ADC can predict active TAO with 87% sensitivity. The ADC parameters of DW-MRI are objective and less operator dependent than the clinical TAO activity scores like VISA classification. A randomized control trial may provide robust data on this correlation.

Doporučení Pracovní skupiny pro idiopatické střevní záněty pro diagnostiku Crohnovy choroby

Background and aims: Recently, the first subcutaneous infliximab (IFX), CTP-13, was approved in the indication of IBD. Pivotal study established noninferiority of subcutaneous infliximab to intravenous formulation in terms of efficacy, with no unexpected safety signals observed. The aims of the study were to evaluate persistency of treatment, pharmacokinetics and safety following a switch from intravenous to subcutaneous infliximab treatment. Methods: This retrospective, single-centre cohort study, recruited all Crohn’s disease (CD) and ulcerative colitis (UC) patients who transitioned from intravenous to subcutaneous IFX between September 2022 and September 2023. Clinical disease activity according to HBI and pMayo, sIBDQ, faecal calprotectin, drug persistence, safety and pharmacokinetics were evaluated at week 24 and 56 after the switch to subcutaneous infliximab. Results: A number of 107 patients was included (63 CD and 44 UC). Quality of life and clinical disease activity scores remained unchanged both in CD and UC. Faecal calprotectin decreased significantly in CD but not in UC. Patients that had been on standard compared to intensified IV infliximab dosing displayed similar outcomes on standard SC dosing. No serious adverse events occurred. Transient local injection reactions were experienced by 4.7% of patients. Median infliximab trough levels significantly increased after the switch to subcutaneous formulation. Conclusion: The switch from intravenous to subcutaneous infliximab is a safe and effective option for the treatment of inflammatory bowel diseases including those with active disease and/ or on intensified intravenous infliximab regime.

Assessment of Schlemm’s canal with swept-source optical coherence tomography in Graves’ ophthalmopathy

PurposeTo evaluate the Schlemm’s canal (SC) parameters obtained by swept-source optical coherence tomography (OCT) different in Graves’ ophthalmopathy (GO) eyes compared to healthy eyes.MethodsThis cross-sectional observational study evaluated 64 eyes of 32 GO cases and 56 eyes of 28 healthy controls. The study was conducted between October 2020 and June 2021. SC images were obtained from the temporal limbus of individuals using swept-source OCT. SC length (SCL) and SC area (SCA) were measured. The relationship between SC parameters in the patient group and intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, Graves’ disease (GD) duration, and clinical activity score (CAS) was evaluated.ResultsIn the GO group, 64 eyes of 32 patients were evaluated, and in the age and gender-matched healthy control group, 56 eyes of 28 individuals were assessed. SC images from 4 eyes of 4 patients in the patient group and 1 eye of 1 patient in the control group were not clear, preventing SCL and SCA measurements for these eyes. SCL and SCA measurements were found to be lower, and IOP and Hertel values were higher in the GO group compared to the healthy controls. However, no significant correlation was observed between SCL and SCA with IOP, RNFL thickness, GD duration, GO duration, or CAS in the GO group. In the GO group, the mean value of SCA was found to be higher in eyes with glaucoma or OHT compared to those without.ConclusionThese findings indicate that SC in GO-affected eyes is shorter and has a smaller area than in healthy individuals. Additionally, higher IOP and Hertel values were observed in the GO group compared to healthy controls. This study suggests that assessing SC using anterior segment OCT could provide valuable insights into the regulation of IOP and the development of glaucoma in GO-affected eyes.

Risk Factors for Ocular Surface Irritation Symptoms in Inactive Mild and Moderate-to-Severe Graves' Orbitopathy.

This study aims to analyze risk factors for ocular surface irritation symptoms in patients with non-corneal-damage inactive mild and moderate-to-severe Graves' orbitopathy (GO). This retrospective study enrolled 307 patients with non-corneal-damage inactive GO admitted to Sun Yat-sen Memorial Hospital from April 2017 to September 2023. The activity and severity of GO were evaluated using the Clinical Activity Score (CAS) and the European Group on Graves' Orbitopathy (EUGOGO) classification, respectively. Multivariate logistic regression analysis was performed to analyze risk factors for ocular surface irritation symptoms. Among patients with inactive GO, for mild cases, CAS (P < 0.001), upper eyelid lag (P = 0.049), and extraocular muscle involvement (P = 0.019) in the symptomatic group were greater than those in the asymptomatic group, and multivariate logistic regression analysis demonstrated that upper eyelid lag (P = 0.048), CAS 1 (P < 0.001), CAS 2 (P = 0.005), and extraocular muscle involvement (P = 0.029) were risk factors for ocular surface irritation symptoms; for moderate-to-severe cases, CAS (P = 0.004), extraocular muscle involvement (P < 0.001), marginal reflex distance 1 (MRD1) (P = 0.030), and thyroid-stimulating hormone (TSH) (P = 0.034) in the symptomatic group were greater than those in the asymptomatic group, while multivariate logistic regression analysis indicated that extraocular muscle involvement (P = 0.018) and MRD1 (P = 0.012) were risk factors for ocular surface irritation symptoms. In non-corneal-damage inactive mild and moderate-to-severe GO, eyelid malposition and periocular muscle inflammation are risk factors for ocular surface irritation symptoms.

Correlation between choroidal vascularity and retrobulbar ocular blood flow changes and thyroid-associated ophthalmopathy activity: a cross-sectional study

ObjectiveTo evaluate the alterations in retrobulbar color Doppler imaging (CDI) parameters and retinal/choroidal optical coherence tomography angiography (OCTA) parameters and their association with the clinical activity and severity in thyroid-associated orbitopathy (TAO) patients.MethodsIn this study, the retrobulbar flow parameters including resistance index (RI), Pulsatile Index(PI), peak systolic velocity (PSV) and end diastolic velocity (EDV) in posterior ciliary artery (PCA), central retinal artery (CRA) and ophthalmic artery (OA) were determined by CDI. Moreover, the retina and choroidal vascularity including the superficial vessel density (SVD), deep vessel density (DVD), choroidal thickness (ChT) and choroidal vascularity, including total choroidal area (TCA), luminal area (LA), stromal area (SA) and Choroidal Vascularity Index (CVI), were determined by OCTA. All patients grouped as active TAO and inactive TAO based on Clinical activity score (CAS). We picked the severe eye among the subjects and compared all parameters between two groups. We analyzed the correlations among those parameters.ResultsThere was a significant difference in CAS score, proptosis value, ChT, LA, CVI between patients with active TAO and inactive TAO. In the active group, PSV and EDV of PCA were significantly higher than the inactive group. On logistic regression analysis, CAS was closely associated with PSV-PCA. On multiple linear regression, proptosis value was closely associated with ChT, LA, SA and CVI.ConclusionChoroidal vascularization and retrobulbar blood flow were concurrently higher in active TAO patients and several variables in choroid circulation was closely related to TAO clinical features.

CORRELATIONSHIP BETWEEN THE LEVEL OF THYROTROPIN RECEPTOR ANTIBODY WITH ACTIVITY AND SEVERITY OF GRAVES’ OPHTHALMOPATHY AT WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR

Abstract&#x0D; Introduction &amp; Objectives : Graves’ Ophthalmopathy (GO) is an autoimmune orbital disease with mostly occurs along with hyperthyroidism. The underlying cause of GO is theoretically connected with thyrotropin receptor that activated antigen-presenting cells from thyrotropin-receptor peptides, then attached with T- helper and B cell that produce the level of thyrotropin receptor antibody (TRAb) and cause an enlargement of orbital tissue and increase the level of triiodothyronine (T3) and thyroxine (T4). To determine the active manifestation status from those clinical findings, the Clinical Activity Score (CAS) is utilised. Meanwhile, European Group on Graves' Orbitopathy (EUGOGO) is used to classify the severity of the disease. This research aims to assess the correlation of TRAb levels toward its activity and severity in patients with Graves’ Ophthalmopathy.&#x0D; Methods : Thirty-four patients with Graves’ Ophthalmopathy underwent clinical and laboratory examinations. The result of clinical finding was plotted into CAS to determine its activity status and EUGOGO to classify its severity. TRAb concentration was measured with ELISA or TBII Assays.&#x0D; Results : All patients have high level TRAb. We analysed the level of TRAb with activity and severity. We found a significant result of cofounding variables related to gender and smoking history, with P value 0.011 and 0.017 respectively. There is no statistically significant result TRAb with activity (CAS) P=0.465, and TRAb with Severity (EUGOGO) P=0.812.&#x0D; Conclusion : The level of TRAb is primarily used as diagnostic marker for Graves’ Ophthalmopathy, but they haveno correlation from the level of TRAb with activity and severity patient with Graves’ Ophthalmopathy.

THERMAL IMAGING ACCURACY ON CLINICAL ACTIVITY SCORE (CAS) THYROID EYE DISEASE PATIENTS

Abstract&#x0D; Introduction &amp; Objectives : Thyroid Eye Disease (TED) also known as Graves' ophthalmopathy, thyroid-associated orbitopathy, and other terms is an autoimmune inflammatory disorder with the most common extra-thyroid manifestations of Graves' Disease (GD). The disease phase is usually assessed clinically, by assessing the presence or absence of cardinal signs and symptoms of inflammation which are assessed in the form of a clinical activity score (CAS). In addition, the use of Thermal Imaging (IT) as a passive measurement technique that does not require contact with the patient (non-invasive and non- contact) and does not use ionizing radiation or contrast agents is another option. The use of TI in patients with TED still has minimal data and does not have more specific results. This study aims to determine the accuracy of TI and CAS images in TED patients.&#x0D; Methods : This study design is accuracy test at the Ophthalmology Polyclinic of RSUP Dr. Mohamad Hoesin Palembang in July 2021 until the sample is filled with 24 people. Thermal Imaging (TI) accuracy test was performed to establish active and inactive TED compared to CAS (Clinical Activity Score) in TED patients. Analysis of research results with SPSS version 22.0.&#x0D; Results : The result shown that the proportion of research subjects who were female was 17 people (70.8%) and male research subjects were 7 people (29.2%). At 7 locations the Thermal Imaging examination was found to have varying sensitivity&#x0D; Conclusion : Thermal Imaging can be used to help diagnose active and inactive TED.

COMPARISON OF TEAR FILM BREAKUP PATTERN IN ACTIVE AND INACTIVE THYROID EYE DISEASE PATIENTS

Abstract&#x0D; Introduction &amp; Objectives : Thyroid Eye Disease (TED) is an autoimmune inflammatory disease of the orbit that affects orbital fat, extraocular muscles, periocular tissue and lacrimal glands. TED activity can be assessed with a Clinical Activity Score (CAS) to identify active or inactive TED conditions. Dry Eye Diseases (DED) is one of the manifestations in patients with TED with a prevalence that varies from 27%-96%. The Asia Dry Eye Society (ADES) 2017 proposed a new concept for DED diagnosis and therapy, namely Tear Film Oriented Diagnosis (TFOD) and Tear Film Oriented Diagnosis Therapy (TFOT) with Tear Film Breakup Pattern (TBUP) examination. TBUP examination help in determine specific management of DED. The aim of this study is to determine the differences in TBUP in TED patients based on active and inactive.&#x0D; Methods : This is an analytical observational study with a cross-sectional design. The subjects were TED patients who came to the Cicendo Eye Hospital and met the inclusion criteria. The study was conducted at the National Eye Center of Cicendo Eye Hospital in April - June 2022. The data were analyzed with the Chi-Square Test.&#x0D; Results : This study was conducted on 23 patients or 46 eyes. This study found a statistically significant differences in TBUP features in active and inactive TED patients (p=0.0001). The most common features of TBUP was found in active TEDs was dimples (55%).&#x0D; Conclusion : There are differences of TBUP features in active and inactive TED patient.

Validation of Indonesian Graves’ Ophthalmopathy Quality of Life Questionnaire and Its Association with Clinical Activity and Severity of Graves’ Ophthalmopathy

Abstract&#x0D; Introduction &amp; Objectives : Graves' ophthalmopathy (GO) ocular abnormalities persisted even after treatment, negatively impacting the patient's psychological and social health. The Indonesian Graves' Ophthalmopathy Quality of Life (GO-QoL) Questionnaire has not been validated; hence it cannot measure patient quality of life in Indonesia, which is crucial to GO treatment. This objective of this study is providinga reliable Indonesian GO-QoL questionnaire and identifying an association between patient quality of life and clinical activity and severity of GO.&#x0D; Methods : The cross-sectional study ran from May through October 2022. Graves' ophthalmopathy and thyroid disease management were the inclusion criteria. Those who could not be reached by video call or controlled for two weeks for test-retest data collection were excluded. The process of questionnaire validation involves transcultural adaptation and cross-sectional design. The content validity index (CVI) and Cronbach's alpha assessed validity and reliability, respectively.&#x0D; Results : Content validity index (CVI) was 1.00 for the Indonesian GO-QoL questionnaire. Cronbach's alpha visual function subscale value was 0.971, while the appearance subscale value was 0.993, and the total score was 0.986. The appearance subscale and total score of GO patients' quality of life had a significant association with the clinical activity score (p&lt;0.05) and disease severity (p&lt;0.001).&#x0D; Conclusion : The Indonesian version of the GO-QoL questionnaire has high validity and reliability values. Patients' appearance and overall quality of life decreases with active Graves' ophthalmopathy. Graves' ophthalmopathy severity decreases quality of life on the appearance and overall subscales.

Selenium supplementation in inactive moderate to severe Graves’ orbitopathy patients: a randomized controlled trial

ABSTRACT Purpose This study was designed to evaluate the effect of selenium supplementation in inactive moderate-severe Graves’ orbitopathy (GO) patients. Methods This study was a single-center, placebo-controlled, double-masked, randomized trial. Inactive moderate-severe GO participants were randomized to receive six months of 200 micrograms/day of selenium supplementation or placebo. Thorough eye exams, clinical activity score (CAS), Graves’ Ophthalmopathy quality of life questionnaire (GO-QOL), and serum selenium level were evaluated at baseline and 6 months after the interventions. The chi-squared or Fisher’s exact test was used to compare categorical variables. The t-test and the paired t-test were used to compare continuous variables between two independent samples and two dependent samples, respectively. Results A total of 25 participants were enrolled, 13 in the selenium group and 12 in the placebo group. Both groups had adequate baseline serum selenium levels at 98.96 ± 15.63 mcg/L and 102.55 ± 17.71 mcg/L, respectively. After 6 months of intervention, the selenium group showed a greater improvement in palpebral aperture (mean difference: −1.4 ± 1.7 mm, p = .04) compared to the placebo group (−0.3 ± 2.7 mm). Notably, 5(41.67%) people in the placebo group developed larger palpebral apertures. Proptosis, ocular motility, and soft tissue signs did not change significantly. GO-QOL and CAS score improvement showed no statistically significant difference between both groups. Minor adverse effects were observed. Conclusions Selenium supplementation has a positive effect on eyelid aperture even in inactive moderate-to-severe GO patients with a sufficient baseline selenium level.

COMPARISON OF TEAR FILM BREAKUP PATTERN IN ACTIVE AND INACTIVE THYROID EYE DISEASE PATIENTS

Introduction: Thyroid Eye Disease (TED) is an autoimmune inflammatory disease of the orbit that affects orbital fat, extraocular muscles, periocular tissue and lacrimal glands. TED activity can be assessed with a Clinical Activity Score (CAS) to identify active or inactive TED conditions. Dry Eye Diseases (DED) is one of the manifestations in patients with TED with a prevalence that varies from 27%-96%. The Asia Dry Eye Society (ADES) 2017 proposed a new concept for DED diagnosis and therapy, namely Tear Film Oriented Diagnosis (TFOD) and Tear Film Oriented Diagnosis Therapy (TFOT) with Tear Film Breakup Pattern (TBUP) examination. TBUP examination help in determine specific management of DED. The aim of this study is to determine the differences in TBUP in TED patients based on active and inactive. Methods: This is an analytical observational study with a cross-sectional design. The subjects were TED patients who came to the Cicendo Eye Hospital and met the inclusion criteria. The study was conducted at the National Eye Center of Cicendo Eye Hospital in April - June 2022. The data were analysed with the Chi-Square Test. Result: This study was conducted on 23 patients or 46 eyes. This study found a statistically significant differences in TBUP features in active and inactive TED patients (p=0.0001). The most common features of TBUP was found in active TEDs was dimples (55%). Conclusion: There are differences of TBUP features in active and inactive TED patient.

The evaluation of retrobulbar fat tissue in Graves' orbitopathy with shear-wave ultrasound elastography.

To evaluate retrobulbar adipose tissue of patients with active and inactive Graves' orbitopathy (GO) by shear-wave ultrasound elastography (SWE). Followed-up in our ophthalmology clinic due to GO, 72 eyes of 36 patients and 38 eyes of 19 healthy controls were included in this cross-sectional case-control study. Graves' patients were divided into two subgroups under clinical activity score (CAS): active Graves' orbitopathy (AGO) (CAS ≥ 3) and inactive Graves' orbitopathy (IGO) (CAS < 3). SWE measurement values of retrobulbar adipose tissue of all participants were recorded in meters/second, and the intergroup comparisons were performed. Thirty-four eyes of 17 patients in AGO, 38 eyes of 19 patients in IGO, and 38 eyes of 19 participants in the control group were included in the study. Mean values measured from retrobulbar adipose tissue through SWE were 1.00 ± 0.01m/sec in AGO, 1.16 ± 0.01m/sec in IGO, and 0.94 ± 0.01m/sec in the control groups. Even so, the mean SWE value was significantly higher in the IGO group than in the other groups (p < 0.001). Mean SWE values were significantly higher in the AGO group than in the controls (p = 0.008). In the correlation analysis performed, a significant positive correlation was found between SWE and Hertel exophthalmometer measurement values (p = 0.026, r = 0.212), and thyroid-stimulating hormone receptor antibody (TSHR-Ab) levels (p = 0.018, r = 0.224). We detected SWE values of retrobulbar adipose tissue high in GO, especially in the IGO group. Such a situation, which we associated with the development of fibrosis, may be an indicator of unresponsiveness to immunomodulatory treatments.

Radiological measurements of lacrimal gland in thyroid eye disease

PurposeLacrimal gland enlargement is a common feature of thyroid eye disease (TED) and has been positively correlated with the clinical activity score. Although lacrimal gland volume is the preferred measure of lacrimal gland size, its calculation is not clinically translatable due to the expertise, time and advanced software required. The aim of our study is to determine whether the lacrimal gland volume in patients with TED undergoing magnetic resonance imaging (MRI) can be estimated using simpler lacrimal gland linear and area measurements.MethodsA retrospective review of 102 orbits (51 patients) with TED who underwent orbital MRI was conducted. The maximum length, width, and area of the lacrimal gland were measured in axial and coronal sections. Lacrimal gland volume was calculated by using a manual segmentation technique on all consecutive axial slices on commercially available software, OsiriX. All quantitative measurements were correlated with the lacrimal gland volume.ResultsMean age of participants was 59 ± 16 years, and 67% (n = 34) were females. With multivariate analyses, combined lacrimal gland axial and coronal areas strongly correlated with volume (r = 0.843, p < 0.01). Strong univariate predictors of volume included axial area (r = 0.704, p < 0.01) and coronal area (r = 0.722, p < 0.01), while moderate predictors included axial length (r = 0.523, p < 0.01), axial width (r = 0.521, p < 0.01), coronal length (r = 0.450, p < 0.01), and coronal width (r = 0.649, p < 0.01).ConclusionIn patients with thyroid eye disease, lacrimal gland volume can be estimated using axial and coronal areas, which is simpler and more time efficient than calculating volumes.

Optical coherence tomography and shear wave elastography findings in Graves ophthalmopathy.

The main feature of Graves ophthalmopathy (GO) is revealed by determining the activity and severity of the disease. We aimed to evaluate the use of imaging methods can also provide additional information about the severity of this disease. Optical coherence tomography (OCT) and shear wave elastography (SWE) findings were compared in 32 patients with mild GO group and in the healthy control group. Measuring for TSH receptor antibody (TRAb) serum level is used third-generation assay. In Graves group, optic nerve sheath diameter (ONSD) values were increased in both eyes (p < 0.001, p < 0.001). SWE measurements showed a significant increase both eye optic nerve (ON) and right eye soft tissue elasticity values in GO group (p < 0.001, p < 0.001, p < 0.001, respectively). There was a significant thinning in left temporal retinal nerve fiber layer (RNFL) thickness and left RNFL peripapillary thickness in GO group (p < 0.001, p < 0.025, respectively). There was a correlation between left eye OCT and SWE findings. Also, there was a significant difference between the median left eye ON and soft tissue elasticity results in the TRAb-positive GO group (p = 0.049, p = 0.048, respectively). SWE measurements showed a significant increase both eyes ONSD, ON and right eye soft tissue elasticity values in GO group. GO group was significant thinning in some left eye regions in OCT measurements. There was a correlation between left eye OCT and SWE findings. In addition to clinical activity score and TRAb, SWE and OCT can be used to monitor in patients with GO.

Prevalence, Clinical and Imaging Characteristics of Superior Ophthalmic Vein Periphlebitis in Thyroid Eye Disease.

To determine the prevalence, clinical features, and radiographic findings of superior ophthalmic vein periphlebitis (SOVP) in thyroid eye disease (TED). Patients with a clinical diagnosis of thyroid eye disease and contrast-enhanced imaging were included. Imaging was reviewed for the presence of SOVP, and patients with SOVP were compared to those without. A random eye was determined to be the affected eye in patients without SOVP. A total of 212 patients met the inclusion criteria. Unilateral SOVP was identified in 4.7% of cases. There was no significant difference in age ( p = 0.22), gender ( p = 0.09), or disease duration ( p = 0.14) between patients with and without SOVP. There was a significant ( p < 0.05) difference in stage classification and clinical activity core between the groups. The affected eye in patients with SOVP had significantly ( p < 0.05) greater margin reflex distance 1, degree of relative proptosis, horizontal motility restriction, and vertical motility restriction than in patients without SOVP. There was no significant difference in horizontal strabismus ( p = 1.0), vertical strabismus ( p = 0.87), or relative intraocular pressure ( p = 0.77). On imaging, the maximal diameter of the SR and IR were found to be significantly ( p < 0.05) larger in the affected eye of patients with periphlebitis; however, there was no difference in measured diameter of the medial rectus and ( p = 0.30) or lateral rectus ( p = 0.78). SOVP is an under-reported imaging finding of thyroid eye disease. It is associated with significantly greater margin reflex distance 1, relative proptosis, and motility restriction on exam as well as larger superior rectus and inferior rectus diameter on imaging. These patients tend to present in the active stage of disease with greater clinical activity score.

A retrospective study of infantile-onset Takayasu arteritis: experience from a tertiary referral center in China.

Takayasu artery (TAK) is a chronic inflammatory disease that mainly affects the aorta and its major branches and is rarely reported in infants. We aimed to summarize the clinical features of infant TA (I-TA) in a tertiary care center. We performed a retrospective study involving 10 infants diagnosed with TAK. A comprehensive evaluation of clinical, laboratory, radiographic features, disease activity, treatment and outcomes was carried out. A consecutive cohort was composed of 8 girls and 2 boys, with an age at diagnosis of 11.1 (1.7-36) months. The median time to diagnosis and the average time to follow-up were 9.5 days (2-235 days) and 10.9 (1-21) months, respectively. The most common initial manifestations were malaise (80%), fever (70%), hypertension (50%) and rash (30%). The mean Pediatric Vasculitis Activity Score (PVAS), Takayasu Clinical Activity Score (ITAS-2010) and ITAS-A scores were 2.8/63, 2.6/51, and 5.6/54, respectively. All patients had aberrant laboratory parameters. The most common lesions were in the thoracic aorta (60%) and abdominal aorta (60%). Corticosteroids combined with cyclophosphamide followed by long-term mycophenolate mofetil were initiated in most cases (70%). Biologics were attempted in 5 cases. Mortality was 40%. It is challenging to diagnose TAK in infants in a timely manner. Considering the more vessels involved, more severe inflammation and higher mortality, aggressive treatment is warranted in infants. GCs and CYC treatment seem to be effective.