Walsh Hannah L, Clauss Kevin D, Meyer Benjamin I, Parunakian Emanuil, Yasar Cigdem, Chiou Carolina A, Johnson Thomas E, Ugradar Shoaib, Kossler Andrea L, Freitag Suzanne K, Douglas Raymond S, Wester Sara T
University of Miami, Miller School of Medicine, Miami, Florida.
Department of Oculofacial Plastic Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmic Plast Reconstr Surg. 2025;41(3):320-328. doi: 10.1097/IOP.0000000000002839. Epub 2024 Dec 10.
To compare regression rates, characteristics, and surgical outcomes of thyroid eye disease patients who underwent orbit, strabismus, or eyelid surgery at various times during or after teprotumumab treatment.
Multicenter, retrospective, observational cohort study.
Adult patients (age >18) with a minimum of 4 infusions of teprotumumab treatment for thyroid eye disease who had had eye surgery during or after treatment.
Two groups were formed based on surgery timing: group 1 (G1) (<180 days since last infusion) and group 2 (G2) (≥180 days since last infusion).
The primary outcome was postoperative regression rates. Secondary outcomes were postoperative regression characteristics, regression treatment, and orbital decompression proptosis reduction.
This study evaluated 53 patients (81% female) who underwent 78 surgeries. G1 comprised 24 individuals with 34 surgeries, while G2 comprised 29 patients with 44 surgeries. Regression rates did not significantly differ between G1 and G2 (20.8% vs. 14.7%, p = 0.611). Compared with G1 patients, patients in G2 who regressed showed a significant mean increase in Clinical Activity Score (4.2 vs. 6.1, p = 0.027) and a nonsignificant yet measured increase in proptosis when compared with those in G1 (2.9 vs. 4.25, p = 0.298) at the time of regression. Compared with G1 patients, G2 patients who regressed were equally likely to undergo a repeat course of teprotumumab as group 1 ( p = 0.14) but underwent a higher number of additional surgical procedures ( p = 0.057). Thyroid stimulating immunoglobin levels uptrended more often in patients who regressed.
Our study suggests that while the rate of regression may not differ significantly, the severity, clinical impact, and need for additional surgery might be more pronounced for patients who have surgery more than 6 months after their last teprotumumab dose.
比较在替普罗单抗治疗期间或之后不同时间接受眼眶、斜视或眼睑手术的甲状腺眼病患者的病情缓解率、特征及手术效果。
多中心、回顾性、观察性队列研究。
年龄大于18岁、因甲状腺眼病接受至少4次替普罗单抗治疗且在治疗期间或之后接受过眼科手术的成年患者。
根据手术时间分为两组：第1组（G1）（自末次输注后<180天）和第2组（G2）（自末次输注后≥180天）。
主要结局为术后病情缓解率。次要结局为术后病情缓解特征、缓解治疗及眼眶减压后突眼度降低情况。
本研究评估了53例患者（81%为女性），共进行了78次手术。G1组有24例患者，进行了34次手术；G2组有29例患者，进行了44次手术。G1组和G2组的病情缓解率无显著差异（20.8%对14.7%，p = 0.611）。与G1组患者相比，病情缓解的G2组患者临床活动评分平均显著升高（4.2对6.1，p = 0.027），且在病情缓解时与G1组患者相比突眼度虽无显著差异但有测量值的升高（2.9对4.25，p = 0.298）。与G1组患者相比，病情缓解的G2组患者接受替普罗单抗重复疗程的可能性与第1组相同（p = 0.14），但接受额外手术的次数更多（p = 0.057）。病情缓解的患者中甲状腺刺激免疫球蛋白水平上升更为常见。
我们的研究表明，虽然病情缓解率可能无显著差异，但对于在末次替普罗单抗剂量后6个月以上进行手术的患者，病情严重程度、临床影响及额外手术需求可能更为明显。
