ABSTRACT
PURPOSE: To assess and quantify teprotumumab's effect on thyroid eye disease-related strabismus by change in measured horizontal and vertical deviations and change in extraocular motility. METHODS: We reviewed a series of patients with thyroid eye disease-related strabismus treated with teprotumumab. Exclusion criteria included age under 18 years, strabismus of alternate etiology, or thyroid eye disease-related reconstructive surgery during the treatment course. Primary outcomes were absolute (prism diopters) and relative (%) differences in horizontal and vertical deviations in primary position at distance, as well as change in ductions of the more affected eye. Secondary outcomes included incidence and timing of strabismus surgery postteprotumumab. RESULTS: Thirty-one patients were included, with mean age 63 years and thyroid eye disease duration 10 months. After teprotumumab, there was 6 prism diopters (39%) mean reduction in vertical deviation ( p < 0.001), without significant change in mean horizontal deviation ( p = 0.75). Supraduction, abduction, adduction, and infraduction significantly improved in the more restricted eye ( p < 0.01, p < 0.01, p = 0.04, and p = 0.01, respectively). Thirty-five percent of patients underwent strabismus surgery posttreatment, at an average 10 months after last infusion. CONCLUSIONS: Teprotumumab produced a statistically significant reduction in vertical but not horizontal strabismus angles in primary position at distance. Extraocular motility in all 4 ductions also improved. A substantial minority of patients still required strabismus surgery following teprotumumab.
Subject(s)
Antibodies, Monoclonal, Humanized , Graves Ophthalmopathy , Strabismus , Humans , Graves Ophthalmopathy/complications , Graves Ophthalmopathy/drug therapy , Graves Ophthalmopathy/diagnosis , Strabismus/physiopathology , Strabismus/surgery , Strabismus/drug therapy , Middle Aged , Male , Female , Aged , Retrospective Studies , Antibodies, Monoclonal, Humanized/therapeutic use , Adult , Oculomotor Muscles/surgery , Oculomotor Muscles/physiopathology , Eye Movements/physiology , Aged, 80 and over , Treatment OutcomeABSTRACT
ABSTRACT: Orbital dermoid cysts are benign choristomas that are very common in children and occur most often as a lateral or medial mass associated with the frontozygomatic or frontoethmoidal suture line. The authors present an unusual case of an occult giant deep orbital dermoid cyst in infancy that initially presented with a small, benign appearance and central upper eyelid location on clinical exam. Orbitotomy with complete excision prevented further ocular sequelae in this 11-month-old.
Subject(s)
Choristoma , Dermoid Cyst , Orbital Neoplasms , Child , Cranial Sutures , Dermoid Cyst/diagnostic imaging , Dermoid Cyst/surgery , Eyelids , Humans , Infant , Orbital Neoplasms/diagnostic imaging , Orbital Neoplasms/surgeryABSTRACT
Superior oblique myokymia (SOM) is an unusual eye movement disorder characterized by recurring episodes of vertical and torsional microtremor of an eye. Visual symptoms include vertical and torsional diplopia, monocular oscillopsia, and tremerous sensations. The disorder is caused by an abnormal firing of the superior oblique muscle in the affected eye. Three cases of SOM will be presented. One of these patients had improvement of her symptoms from the antidepressant drug mirtazapine (Remeron).