Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Published in:

01-02-2022 | Computed Tomography | Oculoplastics and Orbit

Age-related difference in extraocular muscles and its relation to clinical manifestations in an ethnically homogenous group of patients with Graves’ orbitopathy

Authors: Yun Su, Xingtong Liu, Sijie Fang, Yazhuo Huang, Yinwei Li, Sisi Zhong, Yang Wang, Shuo Zhang, Huifang Zhou, Jing Sun, Xianqun Fan

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 2/2022

Abstract

Purpose

To evaluate the age-related difference in EOMs and its relation to clinical manifestations by computed tomography (CT) measurement of EOMs.

Methods

The medical records and CT image review of 40 patients (80 orbits) with moderate-to-severe Graves’ orbitopathy were performed. The patients were divided into two age groups, group 1 (≤ 40 years) and group 2 (> 40 years). CT scans of 30 gender- and age-matched normal controls were also obtained. The maximal cross-sectional area (MCA) and its position (pMCA) of each EOM were measured.

Results

Group 1 presented with more severe proptosis (p < 0.001), while group 2 had a higher risk of diplopia (p < 0.001). Motility restriction in supraduction was more likely to occur in Group 2 (p = 0.027) with even higher severity (p = 0.047). The pMCA was higher in the inferior (p = 0.001), medial (p = 0.021), and lateral rectus (p = 0.013) in group 1. Proptosis was positively correlated to pMCA while diplopia was correlated to MCA in both groups. Significant correlation was noted between restrictions levels and MCA (superior, r = 0.467, p < 0.001; inferior, r = 0.358, p = 0.007; medial, r = 0.314, p = 0.018; lateral, r = 0.308, p = 0.021) or pMCA (inferior, r = − 0.534, p < 0.001) only in group 2.

Conclusions

The muscle enlargement patterns are significantly different between younger and older patients. Older patients tended to have enlarged muscle bellies more posterior in the orbit, which is responsible for more diplopia and motility restriction. Proptosis is more likely to be affected by the most enlarged position than muscle size. So younger patients tended to develop more proptosis and be less bothered by motility restriction even with enlarged muscles.

Bartley GB (1994) The epidemiologic characteristics and clinical course of ophthalmology associated with autoimmune thyroid disease in Olmsted County, Minnesota. Tran Am Ophthalmol Soc 92:477–588

Bahn RS (2010) Graves’ ophthalmopathy. N Engl J Med 362:726–738CrossRef

Bartley GB, Fatourechi V, Kadrmas EF et al (1996) Chronology of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol 121:426–434CrossRef

Perros P, Crombie AL, Matthews JN, Kendall-Taylor P (1993) Age and gender influence the severity of thyroid-associated ophthalmopathy: a study of 101 patients attending a combined thyroid-eye clinic. Clin Endocrinol (Oxf) 38:367–372CrossRef

Manji N, Carr-Smith JD, Boelaert K et al (2006) Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. J Clin Endocrinol Metab 91:4873–4880CrossRef

Ben Simon GJ, Katz G, Zloto O, Leiba H, Hadas B, Huna-Baron R (2015) Age differences in clinical manifestation and prognosis of thyroid eye disease. Graefes Arch Clin Exp Ophthalmol 253:2301–2308CrossRef

Kazim M, Goldberg RA, Smith TJ (2002) Insights into the pathogenesis of thyroid-associated orbitopathy: evolving rationale for therapy. Arch Ophthalmol 120:380–386CrossRef

Hallin ES, Feldon SE (1998) Graves’ ophthalmopathy: I. Simple CT estimates of extraocular muscle volume. Br J Ophthalmol 72:674–677CrossRef

Hallin ES, Feldon SE (1988) Graves’ ophthalmopathy: II. Correlation of clinical signs with measures derived from computed tomography. Br J Ophthalmol 72:678–682CrossRef

10.

Chen YL, Chang TC, Huang KM, Tzeng SS, Kao SC (1994) Relationship of eye movement to computed tomographic findings in patients with Graves’ ophthalmopathy. Acta Ophthalmol (Copenh) 72:472–477CrossRef

11.

Weis E, Heran MK, Jhamb A, Chan AK, Chiu JP, Hurley MC, Rootman J (2012) Quantitative computed tomographic predictors of compressive optic neuropathy in patients with thyroid orbitopathy: a volumetric analysis. Ophthalmol 119(10):2174–2178CrossRef

12.

Bijlsma WR, Mourits MP (2006) Radiologic measurement of extraocular muscle volumes in patients with Graves’ orbitopathy: a review and guideline. Orbit 25:83–91CrossRef

13.

Firbank MJ, Harrison RM, Williams ED, Coulthard A (2001) Measuring extraocular muscle volume using dynamic contours. Magn Reson Imaging 19:257–265CrossRef

14.

Szucs-Farkas Z, Toth J, Balazs E et al (2002) Using morphologic parameters of extraocular muscles for diagnosis and follow-up of Graves’ ophthalmopathy: diameters, areas, or volumes? AJR Am J Roentgenol 179:1005–1010CrossRef

15.

Lennerstrand G, Tian S, Isberg B et al (2007) Magnetic resonance imaging and ultrasound measurements of extraocular muscles in thyroid-associated ophthalmopathy at different stages of the disease. Acta Ophthalmol Scand 85:192–201CrossRef

16.

Lee JY, Bae K, Park KA, Lyu IJ, Oh SY (2016) Correlation between extraocular muscle size measured by computed tomography and the vertical angle of deviation in thyroid eye disease. PLoS One 11:e0148167CrossRef

17.

Bartalena L, Baldeschi L, Boboridis K et al (2016) The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J 5:9–26CrossRef

18.

Mourits MP, Prummel MF, Wiersinga WM, Koornneef L (1997) Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 47:9–14CrossRef

19.

Gunter K, von Noorden EC (1996) Binocular vision and ocular motility: theory and management of strabismus, 5th edn. Mosby, St Louis

20.

Li Y, Su Y, Song X, Zhou H, Fan X (2017) What is the main potential factor influencing ocular protrusion? Med Sci Monit 23:57–64CrossRef

21.

Wiersinga WM, Bartalena L (2002) Epidemiology and prevention of Graves’ ophthalmopathy. Thyroid 12:855–860CrossRef

22.

Li Q, Ye H, Ding Y et al (2017) Clinical characteristics of moderate-to-severe thyroid associated ophthalmopathy in 354 Chinese cases. PLoS One 12:e0176064CrossRef

23.

Regensburg NI, Wiersinga WM, Berendschot TT, Potgieser P, Mourits MP (2011) Do subtypes of graves’ orbitopathy exist? Ophthalmology 118:191–196CrossRef

24.

Kozaki A, Inoue R, Komoto N et al (2010) Proptosis in dysthyroid ophthalmopathy: a case series of 10,931 Japanese cases. Optom Vis Sci 87:200–204CrossRef

25.

Nagy EV, Toth J, Kaldi I et al (2000) Graves’ ophthalmopathy: eye muscle involvement in patients with diplopia. Eur J Endocrinol 142(6):591–597CrossRef

26.

Sas TN, Camen GC, Stefanescu A, Gheonea IA (2015) Imaging evaluation of the orbit in Graves’ ophthalmopathy. Curr Health Sci J 41(3):285–287PubMedPubMedCentral

27.

Nugent RA, Belkin RI, Neigel JM et al (1990) Graves’ orbitopathy: correlation of CT and clinical findings. Radioloy 177(3):675–682

28.

Dagi LR, Zoumalan CI, Konrad H, Trokel SL, Kazim M (2011) Correlation between extraocular muscle size and motility restriction in thyroid eye disease. Ophthalmic Plast Reconstr Surg 27:102–110CrossRef

29.

Nunery WR (1991) Ophthalmic Graves’ disease: a dual theory of pathogenesis. Ophthalmol Clin North Am 4:73-87.4

30.

Nunery WR, Martin RT, Heinz GW, Gavin TJ (1993) The association of cigarette smoking with clinical subtypes of ophthalmic Graves’ disease. Ophthal Plast Reconstr Surg 9:77–82CrossRef

31.

Feldon SE, Weiner JM (1982) Clinical significance of extraocular muscle volumes in Graves’ ophthalmopathy: a quantitative computed tomography study. Arch Ophthalmol 100:1266–1269CrossRef

32.

Feldon SE, Lee CP, Muramatsu SK, Weiner JM (1985) Quantitative computed tomography of Graves’ ophthalmopathy: extraocular muscle and orbital fat in development of optic neuropathy. Arch Ophthalmol 103:213–215CrossRef

Title: Age-related difference in extraocular muscles and its relation to clinical manifestations in an ethnically homogenous group of patients with Graves’ orbitopathy
Authors: Yun Su
Xingtong Liu
Sijie Fang
Yazhuo Huang
Yinwei Li
Sisi Zhong
Yang Wang
Shuo Zhang
Huifang Zhou
Jing Sun
Xianqun Fan
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Diplopia
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 2/2022
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-021-05377-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Age-related difference in extraocular muscles and its relation to clinical manifestations in an ethnically homogenous group of patients with Graves’ orbitopathy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2022

Resource use and economic burden of eye injuries in Southern Finland

Gonioscopy-assisted transluminal trabeculotomy for chronic angle-closure glaucoma: preliminary results

The impact of social distancing on conjunctivitis cases—a retrospective single-center observation report

Characteristics of peripapillary retinal nerve fiber layer atrophy in glaucoma, optic nerve sheath meningioma, and sphenoid wing meningioma

Efficacy of hyaluronic acid 0.3%, cyanocobalamin, electrolytes, and P-Plus in menopause patients with moderate dry eye disease

Can preoperative lacrimal endoscopic evaluation change the paradigm of conventional lacrimal surgery?