Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute.
Department of Statistics, University of California, Los Angeles, California, U.S.A.
Ophthalmic Plast Reconstr Surg. 2024;40(3):270-275. doi: 10.1097/IOP.0000000000002563. Epub 2023 Nov 16.
To compare outcomes of patients with thyroid eye disease treated with teprotumumab or orbital decompression, or both in sequence.
Patients with thyroid eye disease and treated with decompression, teprotumumab, or both were included. Four groups were defined: decompression only, teprotumumab only, teprotumumab first with decompression later, and decompression first with teprotumumab later. The primary outcome was change in exophthalmometry. Secondary outcomes included change in extraocular muscle motility, strabismus, diplopia, and side effects.
One hundred and thirty-nine patients were included. The mean duration for early follow-up was 1.2 months for both decompression and teprotumumab groups. The mean late follow-up was 14.4 and 8.2 months for the decompression and teprotumumab groups respectively. Mean change in exophthalmometry was significantly greater for the decompression group (3.5 mm) compared with teprotumumab (2.0 mm) at late follow-up. Improvement in total extraocular muscle restriction was significantly greater in the teprotumumab group (14.7 degrees) than in the decompression group (2.6 degrees). The teprotumumab group had a significantly higher percentage of patients with diplopia score >1 at baseline and late follow-up ( p < 0.01) compared with the decompression group. Additional treatment with teprotumumab or decompression when previously treated with the opposite had similar proptosis reduction effect as that therapy alone.
Surgical decompression has a greater proptosis reduction effect than teprotumumab, whereas teprotumumab better improves extraocular muscle motility. The addition of teprotumumab or decompression to a previous course of the opposite adds a similar effect to the supplemental treatment alone.
比较甲状腺眼病患者接受替普妥单抗或眼眶减压治疗，或序贯治疗的疗效。
纳入接受减压、替普妥单抗或两者治疗的甲状腺眼病患者。定义了四个组：仅减压、仅替普妥单抗、先替普妥单抗后减压、先减压后替普妥单抗。主要结局是眼球突出度的变化。次要结局包括眼外肌运动、斜视、复视和副作用的变化。
共纳入 139 例患者。减压组和替普妥单抗组的早期随访平均时间为 1.2 个月。减压组和替普妥单抗组的晚期随访平均时间分别为 14.4 个月和 8.2 个月。晚期减压组眼球突出度的平均变化明显大于替普妥单抗组（3.5 毫米）。替普妥单抗组总眼外肌受限的改善明显大于减压组（14.7 度）。与减压组相比，替普妥单抗组基线和晚期随访时复视评分>1 的患者比例显著更高（p<0.01）。与单独治疗相比，先前接受过相反治疗的患者再接受替普妥单抗或减压治疗的效果相似。
手术减压的眼球突出度降低效果优于替普妥单抗，而替普妥单抗更能改善眼外肌运动。在先前的治疗方案中增加替普妥单抗或减压治疗，与单独使用补充治疗效果相似。
