Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.
Ophthalmology, National University Health System, Singapore, Singapore.
Br J Ophthalmol. 2020 Feb;104(2):254-259. doi: 10.1136/bjophthalmol-2018-313578. Epub 2019 May 11.
To evaluate the natural course of upper eyelid retraction (UER) in patients with thyroid eye disease (TED) and factors affecting its course.
Retrospective non-interventional cohort study in a single tertiary institution from March 2006 to March 2015 on patients with TED with (1) unilateral or bilateral UER within 6 months from initial presentation, and (2) no prior interventions nor surgical treatment for their UER. Main outcomes and measures were mean margin reflex distance 1 (MRD1) and factors associated with UER improvement.
There were a total of 61 patients and 81 eyes (41 unilateral and 20 bilateral UER). Mean age was 42.3±15.1 years. Mean MRD1 decreased from 6.1 mm at presentation to 4.8 mm at 12 months, and 4.4 mm at 24 months. The proportion of eyes with normalisation of lid height increased from 0% at presentation to 22.2% at 6 months, 37.0% at 12 months and 49.4% at 24 months. Mean time to normalisation of MRD1 was 18.0±12.4 months. A positive family history of TED was found to be associated with a 6.2 times lower likelihood of normalisation. Change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated to change in MRD1 (p<0.05). There was no correlation between change in MRD1 and thyroid-stimulating hormone receptor antibodies.
An improved knowledge of the natural history of UER in TED will allow us to better decide and evaluate the optimal management for such patients.
评估甲状腺眼病（TED）患者上睑退缩（UER）的自然病程及影响其病程的因素。
这是一项 2006 年 3 月至 2015 年 3 月在一家单中心进行的回顾性非干预性队列研究，纳入了 TED 患者，其具有以下特征：（1）初诊后 6 个月内单侧或双侧 UER；（2）无 UER 的既往干预或手术治疗。主要结局和测量指标为平均角膜反射距离 1（MRD1）和与 UER 改善相关的因素。
共纳入 61 例患者和 81 只眼（41 只单侧 UER 和 20 只双侧 UER）。平均年龄为 42.3±15.1 岁。MRD1 平均值从初诊时的 6.1mm 下降至 12 个月时的 4.8mm 和 24 个月时的 4.4mm。眼睑高度正常化的比例从初诊时的 0%增加到 6 个月时的 22.2%、12 个月时的 37.0%和 24 个月时的 49.4%。MRD1 正常化的平均时间为 18.0±12.4 个月。TED 的阳性家族史与正常化的可能性降低 6.2 倍相关。眼球突出度、临床活动评分和促甲状腺素免疫球蛋白的变化与 MRD1 的变化显著相关（p<0.05）。MRD1 的变化与促甲状腺素受体抗体无相关性。
对 TED 中 UER 的自然病程有更深入的了解，将有助于我们更好地决定和评估此类患者的最佳治疗方案。
