A cohort study of in Thyroid Eye Disease patients with intractable diplopia (TED) attending a metropolitan multidisciplinary service
Author: Meriam Islam
Base Hospital / Institution: Western Eye Hospital
ePoster presentation
Abstract ID: 24-283
Purpose
Intractable diplopia (Gorman grade 3) is one of the most visually disabling manifestations of TED. We aim to describe these patients’ clinical presentation, management, radiological findings and clinical outcomes.
Methods
Retrospective cohort study in TED patients with Gorman 3 attending a Thyroid MDT clinic over 3 years. We collected clinical parameters, quality of life questionnaire data alongside medical and surgical treatment and clinical outcomes. MRI radiological findings were evaluated.
Results
24 Gorman 3 cases were present in 274 patients (8.75%). 62.5% (15/24) were female. Mean age was 56.9 years [30-74]. Hypothyroidism was present in 4.2% (1/24), Hashimoto’s 4.2% (1/24) and Grave’s disease 83.3% (20/24) and 4.2% autoimmune thyroid disease (1/24) and resistance to thyroid hormone in 4.2% (1/24). At presentation, 50.0% were deemed active (12/24). 45.8% (11/24) were severe and 12.5% (3/24) sight threatening. Mean follow up period was 32.7 months [4-71]. At presentation, mean CAS scores were 2.08 [0-5] and mean GOQOL scores for vision (V) was 49.4 [7.14-91.67] and appearance (A) 57.7 [12.5-87.7], and at the end of follow-up was 55.9V and 64.7A. Mean duration of symptoms prior to constant diplopia developing was 14.7 months [0-72]. 45.8% (11/24) had Gorman scores of 3 at presentation, and at the end of follow up 75% (18/24) did, with 45.8% (11/24) using prisms or occlusion and 54.1% (13/24) finding these of no benefit. 87.5% (21/24) had immunosuppression and 33% (8/24) have had orbital decompression and 8.3% (2/24) have had strabismus surgery. Both strabismus patients also had decompression. Of these 8 decompression patients at last review, 12.5% had a Gorman 2 (⅛), 1 was referred elsewhere for strabismus surgery and the remainder 75% (6/8) had a Gorman score of 3. Elevated T2 signal intensity was present in 42% (6/14) and raised ADC values in 57% (8/14).
Conclusion
Treatment of intractable diplopia remains challenging despite immunosuppression and surgery many patients remain significantly symptomatic affecting QOL. It is possible that novel targeted treatments may offer increased treatment efficacy.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Shehnaz | Bazeer | Western Eye Hospital |
| Nour | Houbby | Western Eye Hospital |
| Vickie | Lee | Western Eye Hospital |
