Graves orbitopathy: update on diagnosis and therapy.

Graves orbitopathy (GO) is an autoimmune disorder representing the most frequent extrathyroidal manifestation of Graves disease. It is rare, with an age-adjusted incidence of approximately 16.0 cases per 100,000 population per year in women and 2.9 cases per 100,000 population per year in men. GO is an inflammatory process characterized by edema and inflammation of the extraocular muscles and an increase in orbital connective tissue and fat. Despite recent progress in the understanding of its pathogenesis, GO often remains a major diagnostic and therapeutic challenge. It has become increasingly important to classify patients into categories based on disease activity at initial presentation. A Hertel exophthalmometer measurement of >2 mm above normal for race usually categorizes a patient as having moderate-to-severe GO. Encouraging smoking cessation and achieving euthyroidism in the individual patient are important. Simple treatment measures such as lubricants for lid retraction, nocturnal ointments for incomplete eye closure, prisms in diplopia, or botulinum toxin injections for upper-lid retraction can be effective in mild cases of GO. Glucocorticoids, orbital radiotherapy, and decompression/rehabilitative surgery are generally indicated for moderate-to-severe GO and for sight-threatening optic neuropathy. Future therapies, including rituximab aimed at treating the molecular and immunological basis of GO, are under investigation and hold promise for the future.

Impact of COVID-19 on the Ophthalmology Residency Home-Institution Match Rate.

Purpose The aim of this study was to evaluate the ophthalmology residency match results to determine changes in the rate of home-institution matches during the coronavirus disease 2019 (COVID-19) pandemic. Methods Aggregate deidentified summary match result data from 2017 to 2022 was obtained from the Association of University Professors of Ophthalmology and the San Francisco (SF) Match. A chi-squared test was performed to determine if the rate of candidate matching to the home residency program in ophthalmology was higher in the post-COVID-19 compared with pre-COVID-19 match years. A literature review using PubMed was performed of other medical subspecialty match rates to home institution during the same study period. Results A chi-squared test for difference in proportions confirmed a significantly higher chance of matching to the home program for ophthalmology in the post-COVID-19, SF Match year of 2021 to 2022 compared with 2017 to 2020 ( p = 0.001). Other medical specialties including otolaryngology, plastic surgery, and dermatology also showed similar increased home institution residency match rates during the same time period. Although neurosurgery and urology also had increased trend rates for home institution match rates, these results did not reach statistical significance. Conclusions The ophthalmology home-institution residency SF Match rate was significantly increased during the COVID-19 pandemic year 2021 to 22. This mirrors a trend reported in other specialties including the otolaryngology, dermatology, and plastic surgery in the 2021 match. Additional study will be required to identify factors leading to this observation.