Purpose: 

To evaluate extraocular muscle response to teprotumumab using orbital echography in thyroid eye disease.

Methods: 

This retrospective study included adult thyroid eye disease patients with pre- and post-teprotumumab orbital echography. Data collected included: age, Hertel measurements, clinical activity score, Gorman diplopia scores, ocular motility, and recti muscle diameters measured by echography. The patient’s more proptotic eye before treatment initiation was designated as the study orbit. Ocular motility was assessed by totaling the ductions in all 4 cardinal directions. Orbital echography was obtained pre- and post-treatment to assess response of extraocular muscle diameters.

Results: 

Six patients with a mean age of 67 years were included. There was a mean improvement in proptosis of 4.3 mm in the study eye with 11/12 orbits showing improvement in globe position (p < 0.05). All patients had a decrease in clinical activity score with a mean reduction of 2.5. Four patients had an improvement in Gorman diplopia score. Ocular motility in the study orbits improved by a total mean of 26.9° (p < 0.05). Mean total extraocular muscle diameter was reduced from 27.4 to 23.4 mm (p < 0.001). On average, superior recti were largest pre- and post-treatment, followed by inferior, medial, then lateral recti. However, inferior recti showed the greatest reduction of 23% (p < 0.02).

Conclusions: 

Orbital echography demonstrated extraocular muscle reduction in all patients after teprotumumab, correlating with improved clinical activity score, ocular motility, and proptosis. Orbital echography is a safe and cost-effective imaging alternative to monitor therapeutic response to teprotumumab.

中文翻译：

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眼外肌对 Teprotumumab 反应的超声评估

目的： 

在甲状腺眼病中使用眼眶超声检查评估眼外肌对 teprotumumab 的反应。

方法： 

这项回顾性研究包括接受 teprotumumab 前后眼眶超声检查的成年甲状腺眼病患者。收集的数据包括：年龄、Hertel 测量值、临床活动评分、Gorman 复视评分、眼球运动和通过超声检查测量的直肌直径。治疗开始前患者眼球突出的眼被指定为研究眼眶。通过总计所有 4 个主要方向的感应来评估眼球运动。在治疗前和治疗后获得眼眶超声检查以评估眼外肌直径的反应。

结果： 

包括 6 名平均年龄为 67 岁的患者。研究眼的眼球突出平均改善了 4.3 毫米，11/12 眼眶显示出眼球位置的改善（p < 0.05）。所有患者的临床活动评分均降低，平均降低 2.5。4 名患者的 Gorman 复视评分有所改善。研究眼眶中的眼球运动平均改善了 26.9° ( p < 0.05)。平均总眼外肌直径从 27.4 减少到 23.4 毫米（p < 0.001）。平均而言，上直肠在治疗前和治疗后最大，其次是下直肠、内侧直肠和外侧直肠。然而，下直肌显示出最大的减少 23% ( p < 0.02)。

结论： 

眼眶超声检查显示，teprotumumab 治疗后所有患者的眼外肌均减少，这与临床活动评分、眼球运动和眼球突出相关。轨道超声检查是一种安全且具有成本效益的成像替代方法，用于监测对 teprotumumab 的治疗反应。