Purpose

To investigate associations between orbital phenotypes based on morphological changes and retinal microvascular alterations in Thyroid Eye Disease (TED).

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Methods

This cross-sectional study included 51 patients with TED (102 eyes). All participants underwent comprehensive ophthalmologic examination and TED assessment according to EUGOGO guidelines. Optical coherence tomography angiography (OCTA) was used to evaluate vessel density (VD) in the superficial (SCP) and deep retinal capillary plexuses (DCP) . Magnetic resonance imaging (MRI) with manual segmentation in 3D Slicer was used for volumetric assessment of orbital structures. Associations between orbital tissue volume ratios and retinal vascular parameters were analyzed using linear mixed-effects models adjusted for age, sex, smoking, and hyperlipidemia.

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Results

A higher ratio of extraocular muscle volume to total orbital volume was associated with lower SCP VD in the whole image (β = −63.7, p = 0.002), parafoveal (β = −69.1, p = 0.02), and perifoveal regions (β = −59.7, p = 0.005). Significant negative associations were also observed in temporal and superior parafoveal quadrants and all perifoveal quadrants (all p < 0.05). Increased extraocular muscle volume ratio was additionally associated with reduced DCP VD in the whole image (β = −55.3, p = 0.04) and temporal perifoveal quadrant (β = −64.3, p = 0.04). The ratio of orbital fat volume to total orbital volume showed a positive association with SCP VD in the nasal parafoveal quadrant in the unadjusted model (β = 17.8, p = 0.03).

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Conclusion

A muscle-predominant orbital phenotype in TED is associated with reduced retinal microvascular density, suggesting a link between orbital remodeling and retinal microcirculatory impairment.

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Additional Authors

First name	Last name	Base Hospital / Institution
Ivanka	Maduna	Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek
Laura	Jelusic	University Hospital Center Osijek
Zdravka	Krivdic Dupan	University Hospital Center Osijek. Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek
Dubravka	Biuk	University Hospital Center Osijek. Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek
Jelena	Juri Mandic	School of Medicine, University of Zagreb. University Hospital Center Zagreb,

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