Campi Irene, Currò Nicola, Vannucchi Guia, Covelli Danila, Simonetta Simona, Fugazzola Laura, Dazzi Davide, Pignataro Lorenzo, Guastella Claudio, Lazzaroni Elisa, Pirola Giacinta, Salvi Mario
Division of Endocrine and Metabolic Diseases and Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Thyroid. 2021 Feb;31(2):280-287. doi: 10.1089/thy.2020.0165. Epub 2020 Oct 22.
The overall changes of ocular motility in Graves' orbitopathy (GO) are not easily quantifiable with the methods currently available, especially in clinical studies. The aim of the present study was to calculate parameters that quantify the changes of ocular motility in GO in relation to the Gorman score for diplopia. We studied 100 GO patients (Group 1) and 100 controls (Group 2). We also included 30 patients treated with intravenous methylprednisolone (iv-MP), assessed at baseline and after 12 and 24 weeks (Group 3), and 66 patients submitted to squint surgery, assessed at baseline and after 12 weeks (Group 4). Ocular ductions were measured in four gaze directions by a perimeter arc and were used to calculate a total motility score (TMS) as the sum of ductions in each direction; a biocular TMS (b-TMS) as the sum of the TMS of two eyes; and an asymmetry ratio (AR) as the sum of the differences of the corresponding ductions between the two fellow eyes divided by the mean difference found in controls. Quality of life was accessed by a specific questionnaire (Graves' orbitopathy quality of life [GO-QoL] questionnaire). TMS and b-TMS were lower, while AR was higher, in Group 1 compared with controls ( < 0.001). In Group 1, TMS and b-TMS were inversely correlated with the Gorman score ( < 0.001) and AR was higher in patients with constant diplopia compared with the others ( < 0.001). In Group 3, TMS and b-TMS increased after treatment in responders to iv-MP ( < 0.001). In Group 4, TMS and b-TMS improved in all patients after surgery ( < 0.01), while AR and GO-QoL score improved only in those without residual constant diplopia ( < 0.001). We describe a quantitative method to assess eye motility dysfunction in any stage of GO to be used as an outcome measure in clinical studies.
目前可用的方法难以轻易量化格雷夫斯眼眶病（GO）中眼球运动的总体变化，尤其是在临床研究中。本研究的目的是计算一些参数，这些参数可量化GO中眼球运动变化与复视的戈尔曼评分之间的关系。我们研究了100例GO患者（第1组）和100例对照者（第2组）。我们还纳入了30例接受静脉注射甲泼尼龙（iv-MP）治疗的患者，在基线、12周和24周后进行评估（第3组），以及66例接受斜视手术的患者，在基线和术后12周进行评估（第4组）。通过周边弧形装置在四个注视方向测量眼球转向，并用于计算总运动评分（TMS），即每个方向上眼球转向的总和；双眼TMS（b-TMS），即双眼TMS的总和；不对称率（AR），即两眼相应眼球转向差异的总和除以在对照者中发现的平均差异。通过一份特定问卷（格雷夫斯眼眶病生活质量[GO-QoL]问卷）评估生活质量。与对照者相比，第1组的TMS和b-TMS较低，而AR较高（<0.001）。在第1组中，TMS和b-TMS与戈尔曼评分呈负相关（<0.001），与其他患者相比，持续性复视患者的AR更高（<0.001）。在第3组中，对iv-MP有反应的患者治疗后TMS和b-TMS升高（<0.001）。在第4组中，所有患者术后TMS和b-TMS均有改善（<0.01），而AR和GO-QoL评分仅在无残余持续性复视的患者中有所改善（<0.001）。我们描述了一种定量方法，用于评估GO任何阶段的眼球运动功能障碍，可作为临床研究中的一项结果指标。
