Maglionico Maria Novella, Lanzolla Giulia, Figus Michele, Cosentino Giada, Comi Simone, Marinò Michele, Santini Ferruccio, Posarelli Chiara
Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa, Pisa, Italy.
Department of Clinical and Experimental Medicine, Endocrinology Unit I-II, University of Pisa and University Hospital of Pisa, Pisa, Italy.
Front Endocrinol (Lausanne). 2024 Dec 5;15:1428185. doi: 10.3389/fendo.2024.1428185. eCollection 2024.
Graves' Orbitopathy (GO) is an autoimmune disorder characterized by inflammation of orbital tissues, leading to various ocular manifestations, including ocular surface disease. This cross-sectional study aimed to assess the presence of ocular surface disease using the Ocular Surface Disease Index (OSDI) in patients with Graves' disease (GD) and moderate-to-severe active GO compared to those with GD and mild non-active GO. Additionally, we aimed to investigate the correlation between ocular surface disease and the eye features of GO.
Consecutive GD patients with GO referred to the Ophthalmology and Endocrinology Units of the University Hospital of Pisa between June 2022 and February 2023 were enrolled. OSDI scores were obtained from 79 GD patients, categorized into moderate-to-severe active GO and mild non-active GO groups.
OSDI scores were significantly higher in patients with moderate-to-severe active GO compared to those with mild non-active GO (P=0.0006). A cutoff value of 33 for positive tests revealed a higher frequency of pathological OSDI in moderate-to-severe active GO patients compared to mild non-active GO patients (P=0.0221; OR 3.673, CI 1.277-9.531). Within the moderate-to-severe active GO group, a significant positive correlation was found between OSDI and Clinical Activity Score (CAS) (R= 0.3867, 95% CI from 0.1403 to 0.5880; P=0.0030). Using a cutoff value of 55 (the 75th percentile of the study population), patients with CAS ≥ 3 had a significantly higher proportion of pathological OSDI compared to those with CAS <3 (P=0.0039; OR 4.075, CI 1.619-10.39). Proptosis values ≥ 22 mm and the presence of lagophthalmos were identified as significant risk factors for ocular surface disease development (P=0.0406 and P=0.0493, respectively).
Our study highlights a significantly higher prevalence of ocular surface disease, as measured by OSDI, in patients with moderate-to-severe active GO compared to those with mild non-active disease. The degree of GO activity positively correlates with ocular surface involvement, and proptosis and lagophthalmos increase the risk of its occurrence. These findings emphasise the importance of assessing and managing ocular surface health in GO patients. Early identification and appropriate treatment of ocular surface disease need to be pursued to improve patient management.
格雷夫斯眼眶病（GO）是一种自身免疫性疾病，其特征为眼眶组织炎症，可导致包括眼表疾病在内的各种眼部表现。本横断面研究旨在使用眼表疾病指数（OSDI）评估格雷夫斯病（GD）合并中重度活动性GO患者与GD合并轻度非活动性GO患者眼表疾病的存在情况。此外，我们旨在研究眼表疾病与GO眼部特征之间的相关性。
纳入2022年6月至2023年2月期间转诊至比萨大学医院眼科和内分泌科的连续GO患者。从79例GD患者中获取OSDI评分，这些患者分为中重度活动性GO组和轻度非活动性GO组。
与轻度非活动性GO患者相比，中重度活动性GO患者的OSDI评分显著更高（P = 0.0006）。阳性测试的临界值为33时，中重度活动性GO患者病理性OSDI的频率高于轻度非活动性GO患者（P = 0.0221；OR 3.673，CI 1.277 - 9.531）。在中重度活动性GO组中，OSDI与临床活动评分（CAS）之间存在显著正相关（R = 0.3867，95%CI从0.1403至0.5880；P = 0.0030）。使用临界值55（研究人群的第75百分位数），CAS≥3的患者病理性OSDI的比例显著高于CAS<3的患者（P = 0.0039；OR 4.075，CI 1.619 - 10.39）。眼球突出值≥22 mm和存在兔眼被确定为眼表疾病发生的显著危险因素（分别为P = 0.0406和P = 0.0493）。
我们的研究强调，与轻度非活动性疾病患者相比，中重度活动性GO患者中通过OSDI测量的眼表疾病患病率显著更高。GO活动程度与眼表受累呈正相关，眼球突出和兔眼会增加其发生风险。这些发现强调了评估和管理GO患者眼表健康的重要性。需要对眼表疾病进行早期识别和适当治疗，以改善患者管理。
