From the Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (H.J.B., J.K., J.S.Y.).
Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego, San Diego, California, USA (D.O.K.).
Am J Ophthalmol. 2024 Feb;258:110-118. doi: 10.1016/j.ajo.2023.07.020. Epub 2023 Aug 4.
Rehabilitative orbital decompression treats disfiguring exophthalmos in patients with Graves' orbitopathy (GO). This study aimed to identify risk factors associated with the postoperative recurrence of proptosis after orbital decompression.
Retrospective, case-control study.
This retrospective review included patients with GO who underwent rehabilitative orbital decompression for disfiguring proptosis in an inactive state with a low clinical activity score (0-2) between January 2017 and December 2020 by a single surgeon. Exophthalmos was measured using a Hertel exophthalmometer, and recurrence was defined as an increase of 2 mm or more after decompression during the follow-up period. The association between preoperative variables and proptosis recurrence was analyzed using multivariable logistic regression.
Of the total 217 patients, 11 (5.1%) developed recurrence of proptosis during the follow-up period (range, 3-30; mean, 15.6 months). Univariate logistic regression analysis identified thyroid-stimulating hormone receptor antibody (TRAb) and thyroid-stimulating immunoglobulin (TSI) as significant factors for recurrence, with age, sex, smoking, disease duration, orbital radiotherapy, and total thyroidectomy history being nonsignificant. TRAb remained significant in a multivariate logistic regression analysis (odds ratio, 1.06; P = .014). Receiver operating characteristic curve analysis revealed an area under the curve of 0.86 with a sensitivity of 90.9% and specificity of 82.0% at a TRAb level of 7.96 IU/L.
Preoperative TRAb and TSI are valuable markers to predict proptosis recurrence after orbital decompression. These results may help surgeons to decide the optimal timing for orbital decompression to lessen the risk of postoperative recurrence of proptosis.
修复性眼眶减压术治疗格雷夫斯眼病（GO）患者的致畸形眼球突出。本研究旨在确定与眼眶减压术后眼球突出复发相关的危险因素。
回顾性病例对照研究。
本回顾性研究纳入了 2017 年 1 月至 2020 年 12 月间由同一位外科医生进行的修复性眼眶减压术治疗静止期、临床活动评分低（0-2）的致畸形眼球突出的 GO 患者。使用 Hertel 突眼计测量眼球突出度，减压后随访期间增加 2mm 或以上定义为复发。采用多变量逻辑回归分析术前变量与眼球突出复发的关系。
在 217 例患者中，11 例（5.1%）在随访期间发生眼球突出复发（范围 3-30 个月，平均 15.6 个月）。单变量逻辑回归分析发现促甲状腺激素受体抗体（TRAb）和促甲状腺刺激免疫球蛋白（TSI）是复发的显著因素，而年龄、性别、吸烟、疾病持续时间、眼眶放疗和甲状腺全切除术史无显著意义。TRAb 在多变量逻辑回归分析中仍有意义（优势比，1.06；P=0.014）。受试者工作特征曲线分析显示曲线下面积为 0.86，TRAb 水平为 7.96IU/L 时，敏感度为 90.9%，特异度为 82.0%。
术前 TRAb 和 TSI 是预测眼眶减压术后眼球突出复发的有价值的标志物。这些结果可能有助于外科医生决定眼眶减压术的最佳时机，以降低术后眼球突出复发的风险。
