Purpose

Evaluate choroidal vascularity index (CVI), central macular thickness (CMT), peripapillary retinal nerve fiber layer (RNFL), and optic disc morphometry in Graves’ ophthalmopathy (GO) versus healthy controls, and correlate with proptosis severity.

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Methods

Prospective case-control study: 30 GO patients (54 eyes) and 39 controls (70 eyes). Groups were age-matched (GO 42.8 ± 13.9 vs. control 41.8 ± 14.8 years). Enhanced-depth imaging OCT measured CVI (choroidal vascularity ratio), CMT, peripapillary RNFL (average and quadrants), and optic disc parameters. GO eyes stratified by proptosis (Hertel): normal ≤20 mm (10), mild 21–23 mm (22), moderate 24–26 mm (20), severe >26 mm (8). Mann-Whitney U test for group comparisons; Spearman correlation for proptosis associations (α = 0.05).

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Results

Mean Hertel exophthalmometry: GO 23.4 ± 2.6 mm, controls 16.4 ± 3.6 mm. CVI was equivalent (62.28 vs. 62.55%; p = 0.202) and independent of proptosis (r = 0.009, p = 0.950). CMT preserved in both groups (291.4 vs. 291.7 µm; p = 0.912), unrelated to proptosis degree (r = 0.097, p = 0.484). Average RNFL and quadrants showed no significant differences (p > 0.05), though inferior RNFL trended toward thinning in GO (128.2 vs. 123.9 µm; p = 0.065). Optic disc area was significantly larger in GO (2.06 vs. 1.85 mm²; p = 0.029). Within GO, inferior RNFL correlated significantly with proptosis (r = −0.346, p = 0.010), indicating progressive thinning with increasing proptosis. Cup-to-disc ratio >0.6 occurred in 25.9% of GO eyes.

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Conclusion

Choroidal and macular structural integrity remained preserved in GO independent of proptosis severity. Conversely, optic disc enlargement and inferior RNFL thinning—particularly in proportion to proptosis—suggest subclinical mechanical optic nerve stress. These findings require prospective validation to determine clinical utility as predictive biomarkers for dysthyroid optic neuropathy progression or surgical timing in Graves’ ophthalmopathy.

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Additional Authors

First name	Last name	Base Hospital / Institution
Fatih Ali	Ceylan	Gaziantep City Hospital
Mustafa	Berhuni	Gaziantep Islam Science and Technology University
Sadettin	Özturk	Gaziantep City Hospital

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