Lixi Filippo, Cuccu Alberto, Giannaccare Giuseppe, Onnis Matteo, Timofte Zorila Mihaela Madalina, Mariotti Stefano, Vacca Rosanna, Meloni Paola Elisa, Pisu Michela, Mura Chiara, Boi Francesco
Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy.
Department of Ophthalmology, Cai Ferate Clinical Hospital, 1 Garabet Ibraileanu Street, 700506 Iasi, Romania.
J Pers Med. 2024 Aug 10;14(8):848. doi: 10.3390/jpm14080848.
This study aimed to investigate the presence of structural and functional changes in extraocular muscles (EMs) among patients with inactive Graves' orbitopathy (GO) classified according to the Clinical Activity Score (CAS). Sixty-seven patients with Graves' disease (GD) and inactive GO were included. The data collected included clinical parameters, thyroid function, autoantibody levels, EOM morphology via orbital ultrasound (US), and ocular motility. Patients were stratified into Red Filter Test (RFT)-positive or RFT-negative groups based on the presence or absence of latent diplopia during the RFT examination. Thirty-three patients (49.25%) exhibited latent diplopia on the RFT, despite not reporting double vision during standard ocular motility tests. Significant differences were observed between the two groups in terms of age, disease duration, intraocular pressure (IOP) elevation in up-gaze, and medial rectus muscle thickness ( < 0.05). No significant differences were found in thyroid status, TRAb and ATA levels, CASs, exophthalmos, or lateral rectus thickness between the two groups. This study revealed that in inactive GO, subclinical EM dysfunction and morphological changes may be present, which might not be apparent through routine ocular examinations. The RFT is effective in detecting latent diplopia, highlighting its utility in identifying subtle ocular motility issues and subclinical muscle involvement. Comprehensive evaluations combining functional tests like the RFT and imaging are essential for early detection of GO-related abnormalities, enabling tailored and prompt management and improving patient outcomes.
本研究旨在调查根据临床活动评分（CAS）分类的静止期格雷夫斯眼眶病（GO）患者眼外肌（EM）的结构和功能变化情况。纳入了67例格雷夫斯病（GD）合并静止期GO患者。收集的数据包括临床参数、甲状腺功能、自身抗体水平、通过眼眶超声（US）测量的眼外肌形态以及眼球运动情况。根据红色滤光片试验（RFT）检查中是否存在潜在复视，将患者分为RFT阳性或RFT阴性组。33例患者（49.25%）在RFT检查中表现出潜在复视，尽管在标准眼球运动测试中未报告复视。两组在年龄、病程、上视时眼压（IOP）升高以及内直肌厚度方面存在显著差异（<0.05）。两组在甲状腺状态、促甲状腺素受体抗体（TRAb）和抗甲状腺过氧化物酶抗体（ATA）水平、CAS、眼球突出度或外直肌厚度方面未发现显著差异。本研究表明，在静止期GO中，可能存在亚临床眼外肌功能障碍和形态学变化，而这些变化通过常规眼部检查可能并不明显。RFT在检测潜在复视方面有效，突出了其在识别细微眼球运动问题和亚临床肌肉受累方面的实用性。将RFT等功能测试与影像学相结合的综合评估对于早期发现GO相关异常至关重要，能够实现针对性的及时管理并改善患者预后。
