Optic Nerve Head Vessel Density Changes from Graves' Disease without TED to TED Dysthyroid Optic Neuropathy: Does Optic Nerve Head Ischemia Play a Role?

PURPOSE: To compare the retinal peripapillary capillary (RPC) vessel density (VD) between 5 groups of patients on the spectrum of thyroid eye disease (TED). METHOD: This is a prospective comparative study looking at 5 groups of patients who were consecutively included from January 2018 to March 2021. They were composed of: Healthy volunteers (39 eyes and 20 subjects), patients with Graves' disease without TED (26 eyes and 13 patients), mild TED (28 eyes and 14 patients), moderate-severe TED (30 eyes and 17 patients), and TED with dysthyroid optic neuropathy (DON) (21 eyes and 12 patients). Ocular and periocular examination, visual field indices, RPC-VD (with optical coherence tomography angiography), and retinal nerve fiber layer, and macular ganglion cell complex thickness were recorded. RESULT: An initial insignificant (0.5 < p < 0.9) rise in the peripapillary-VD (pp-VD) and whole image-VD (wi-VD) from the healthy subject to the Graves' disease without TED was followed by a significant (p = 0.001) fall in RPC-VD in different severity grades of the TED. Paired comparison between the 5 groups showed that the statistically significant fall from the Graves' disease group occurred in the moderate-severe and DON groups (0.001 ≤ p ≤ 0.04). No variable significantly affected the VD (0.08 ≤ p ≤ 0.9). A lower wi-VD and pp-VD were significantly (0.001 ≤ p ≤ 0.009) correlated with the impaired optic nerve functional and structural tests. The sensitivity and specificity of wi-VD (81% and 76%) and pp-VD (69% and 71%) for detecting the DON were statistically significant (p < 0.001). CONCLUSION: Despite an insignificant rise in the wi- and pp-VD from the healthy volunteers to the patients with Graves' disease without TED, VD showed a declining trend in the course of patients with TED, which was statistically significant in the moderate-severe TED and DON groups.

Postoperative levator function change in patients with unilateral myogenic versus aponeurotic blepharoptosis.

PURPOSE: To compare the change in levator function (LF) after levator resection in patients with unilateral myogenic (MP) and aponeurotic ptosis (AP). METHODS: In a prospective study, patients of >5 years old were included from June 2015 to April 2017. Other types of ptosis, associated strabismus and previous eyelid surgery were excluded. Eyelid examination and photography were performed before and at least 6 months after surgery. Success was defined as Margin reflex distance 1 (MRD1) of within 0.5 mm of the unoperated side. All procedures (levator resection) were performed by or under supervision of one surgeon. RESULTS: There were 58 patients in the MP (mean age: 19.2 years) and 20 in the AP (mean age: 49.5) group with median follow up of 10 months. LF was significantly improved from 5.8 to 7.3 mm in the MP and from 11.8 to 13.6 mm in the AP group. LF improvement was not observed in 17.2% of MP and 25% of AP group (P = 0.5). Mean preoperative LF was significantly (Odd ratio = 1.8) higher in patients with than without LF improvement in the MP group. It was significantly reverse in the AP group (Odd ratio = 0.38). A significantly positive (r = 0.30) and negative (r = -0.72) correlations were observed between preoperative LF and LF improvement in the MP and AP groups, respectively. Success was observed in 90% of AP and 84.5% of MP group. In order of frequency, undercorrection, overcorrection, and contour abnormality were the reasons for failure. No variable significantly affected the success rate in either group. CONCLUSION: Majority of MP and AP showed postoperative LF improvement. While higher preoperative LF was significantly correlated with LF improvement in the MP, it was reverse in the AP group. Success rate was not significantly different between the groups and no factor significantly affected the success in either group.

Subjective versus objective dry eye disease in patients with moderate-severe thyroid eye disease.

PURPOSE: To compare the subjective versus Objective dry eye disease (DED) in patients with moderate-severe thyroid eye disease (TED). METHOD: Included were the patients with moderate-severe TED and ≥18 years old. They completed the ocular surface disease index (OSDI) questionnaire and had Schirmer, Tear breakup time (TBUT), fluorescein staining, osmolarity, corneal aesthesiometry, and meibomian gland dysfunction (MGD) tests. Excluded were patients with history of any disease, surgery and or medications which might be affecting the ocular surface and incomplete tests results. Subjective DED was defined as OSDI score of ≥13 and objective as one abnormal sign (TBUT, Schirmer, Osmolarity, and Staining). Presence of both was defined as definite DED. RESULTS: Included were 38 patients (74 eyes) with mean age of 40 years. Subjective DED was detected in 77%, objective in 89.2%, and definite in 67.7% of the eyes. Severe subjective and objective DED were found in 36.5% and 24.3% of the eyes, respectively. TBUT was the most frequent positive test (63.5%). MGD was observed in 56.8% of the eyes. Mean clinical activity score, palpebral fissure, rundle grading, proptosis, corneal aesthesiometry, and presence of MGD were not significantly different between the eyes with and without subjective, objective, or definite DED. CONCLUSION: Definite DED was found in more than 2/3 of the eyes with moderate-severe TED. While frequency of objective DED was higher, severe form of subjective DED was more frequent. No variable was significantly different between the eyes with and without subjective, objective and definite DED.