https://doi.org/10.31288/oftalmolzh201416873

State of extraocular muscles in patients with endocrine ophthalmopathy according to computer tomography

A. Kayali

SI «The Filatov Institute of Eye Diseases and Tissue Therapy of the AMS of Ukraine»

Introduction. Endocrine ophthalmopathy (EOP) is the most common cause of not only bilateral but unilateral exophthalmos. Differential diagnosis of unilateral exophthalmos demands to exclude other pathologies of orbit and periorbital sinuses. CT and MRI at the present stage are the «gold standard «for the differential diag-nosis of pathological conditions in orbit.

Objective. To examine the state of the extraocular muscles in patients with EOC by computer tomography.

Material and methods. CT performed in 158 EOP patients using the «Somatom» («Siemens») and spiral computed tomography «Astenion-SUPER-4» firms  «Toshiba» by the conventional method. Age of patients ranged from 23 to 77 years, there were 53 men, 105 women. Unilateral exophthalmos diagnosed in 25.9 % of cases, two-sided — in 74.1 %. There were 102 (64.5 %) patients with hyperthyroidism, 35 (22.2 %) with hypothyroidism, 21 (13.3 %) with euthyroid. According to the classification of A. F. Brovkina EOP thyrotoxic exophthalmos installed in 46.2 % of cases, edematous — 43.6 %, endocrine myopathy — 8.8 %. In two patients (1.3 %) with EOP classification group of A. F. Brovkina was not determined. During CT studied the state of extraocular muscles (EOM), optic nerve, retro-bulbar tissue. CT findings were recorded in an electronic database created and processed using the statistical program «Statistics 9.»

Results. It was revealed that often affects the internal rectus — 98 patients (62.0 %) and lower — 93 patients (58.9 %), at least the upper — 72 patients ( 45.6 %) and external — 63 patients ( 39.9 %). In hyperthyroidism often marked change in the lower (75.9 %) and internal (65.5 %) rectus of the eye, hypothyroidism — internal (87.5 %), with euthyroid equally eye all muscles increased in 50.0 % of cases.

When thyrotoxic and edematous exophthalmos often affected equally all the muscles except the lateral rectus, which is 2 times more increased at thyrotoxic exoph-thalmos.

Conclusions. Found that according to CT more frequently (95.6 %) revealed myo- genic form of EOP. The changes of EOM depend on the thyroid function and the clinical form of the thalmopathy EOP.

Key words: computed tomography, extraocular muscles, endocrine ophthalmology

References

1.Бровкина А. Ф. Эндокринная офтальмопатия / Алевтина Федоровна Бровкина. — М., ГОЭТАР, 2004. — 174 с.

2.Assessment of optic nerve compression in Graves' ophthal-mopathy / N. M. C. So, W. W. M. Lam, G. Cheng [et al] // Acta Radiol. — 2000. — V 41. — Is. 6. — P. 559.
Crossref

3.Bartalena L. Management of Graves' Ophthalmopathy: Reality and Perspectives / L. Bartalena, A. Pinchera, .Marcocci // Endocrine Reviews. — 2000. — V.21. — № 2. — Р. 168- 199.
Crossref

4.Clinical Significance of Saccade Analysis in Early Active Graves' Ophthalmopathy / H. D. Schworm, A. E. Heufelder, A. Kunze [et al] // Invest.Ophth. Vis. Sc. — 2000. — V1. — P.1710-1718.

5.Cockerham K. P. Does radiotherapy have a role in the management of thyroid orbitopathy? View / K. P. Cockerham, J. S. Kennerdell // Br. J. Ophthalmol. — 2002. — V.86. — P.102- 107.
Crossref

6.Computer analysis of orbital fat and muscle volumes in Graves ophthalmopathy / G. Forbes, C. A. Gorman, D.Gehring [et al] // Am. J. NeuroRadiol. - 1983, V 4. — Is. 3. — P. 737-740.

7.CT scan evidence of dysthyroid optic neuropathy / J. A. Giaconi, M. Kazim, T. Rho, C. Pfaff // Ophthal. Plast. Reconstr. Surg. — 2002, V 18. — N 3. — P. 177- 182.
Crossref

8.El-Kaissi S. / Thyroid-associated ophthalmopathy: a practical guide to classification, natural history and management / S. El-Kaissi, A. G. Frauman, J. R. Wall // Intern. Med. J. — 2004. — V 34. — № 8. — P.482-491.
Crossref

9.Evaluation of extraocular muscle enlargement in dysthyroid ophthalmopathy / Y Murakami, T. Kanamoto, T. Tuboi [et al] // Jpn. J. Ophthalmol. — 2001. — V.45. — № 6. — P.622- 627.
Crossref

10.Follow-up of transnasal orbital decompression in severe Graves' ophthalmopathy / O. Michel, N. Oberl?nder, P. Neugebauer // Ophthalmology. — 2001. — V.108. — P.400-404.
Crossref

11.Fung S. Thyroid orbitopathy / S. Fung, R. Malhotra, D. Selva // Aust. Fam. Physician. — 2003. — V. 32. — № 8. — P. 615-620.

12.Garrity J. A. Pathogenesis of graves ophthalmopathy: implications for prediction, prevention, and treatment / J. A. Garrity, R. S. Bahn // Am. J. Ophthalmol. — V. 142. — № 1. — P. 147- 153.

13.Graves' ophthalmopathy: Eye muscle involvement in patients with diplopia / E. V. Nagy, J. Toth, I. Kaldi [et al] // ,Eur. J. Endocrinol. — 2000. — V. 142. — № 6. — P. 591-597.

14.Graves ophthalmopathy: intracranial fat prolapse on CT images as an indicator of optic nerve compression / D. Birchall, R. L. Goodall, J. L. Noble [et al] // Radiology. — 1996. — V 200. — P.123- 127.

15.Graves orbitopathy: correlation of CT and clinical findings / R. A. Nugent, R. I. Belkin, J. M. Neigel [et al] // Radiology. — 1990. — V.177. — № 3. — P. 675- 682.

16.Isolated hypertrophy of the superior oblique muscle in Basedow disease / Charif Chefchaouni M., A. Bernoussi, Z. Hajji [et al] // Bull. Soc. Beige.Ophtalmol. — 2005. — V.295. — P.11-15.

17.Kahaly G. J. Recent developments in Graves' ophthal-mopathy imaging / G. J. Kahaly //J. Endocrinol. Invest. — 2004. — V.27. — № 3. — P. 254- 258.

18.Magnetic resonance imaging and ultrasound measurements of extraocular muscles in thyroid-associated oph-thalmopathy at different stages of the disease / G. Lenne-rstrand, S. Tian, B. Isberg [et al] // Acta Ophthalmol.Scand. — 2007. — V.85. — № 2. — P. 192-201.

19.Ophthalmopathy of Graves' disease: computerized volume measurements of the orbital fat and muscle / G. Forbes, C.A. Gorman, M. D. Brennan [et al] // Am. J. NeuroRadiol. — 1986, V 7. — Is. 4. — P. 651-656.

20.Orbital computed tomographic characteristics of globe subluxation in thyroid orbitopathy / P. A. Rubin, L. M. Watkins, S. Rumelt // Ophthalmology. — 1998, V 105. — N 11. — P. 2061- 2064.

21.Perros P. Clinical presentation and natural history of Graves' ophthalmopathy / P. Perros, A. J. Dickinson, P. Kendall-Taylor // In Bahn R (Ed) Thyroid Eye Disease. Kluwer Academic Publishers, Boston. — 2001. — P. 119138.

22.Signal intensity, clinical activity and cross-sectional areas on MRI scans in thyroid eye disease / E. J. Mayer, D.L. Fox, G. Herdman // Eur. J. Radiol. — 2005. — V 56. — № 1. — P. 20- 24.

23.Superior oblique muscle involvement in thyroid ophthal-mopathy / N. M. Thacker, F. G. Velez, J. L. Demer [et al] // J AAPOS. — 2005. — V9. — № 2. — P. 174- 178.

24.The study of visual evoked potentials in patients with thyroid-associated ophthalmopathy identifies asymptomatic optic nerve involvement / M. Salvi, E. Spaggiari, F. Neri [et al] // J. Clin. Endocrinol. Metab. — 1997. — V.82. — № 4. — P. 1027- 1030. 

25.Thyroid-associated ophthalmopathy: a clinical study of 381 cases / Sun H., Jiao Q., Tan L. [et al] // Zhonghua Nei Ke Za Zhi. — 2006. — V.45. — № 5. — P.400- 402.

26.Trokel S. L. Correlation of CT scanning and pathologic fea-tures of ophthalmic Graves' disease / S. L. Trokel, F. A. Jako-biec // Ophthalmology. — 1981, V 88. — N 6. — p. 553- 564.

27.Trokel S. Orbital fat removal. Decompression for Graves orbitopathy / S. Trokel, M. Kazim, S. Moore // Ophthal-mology. — 1993, V 100. — № 5. — P.674- 682.

28.Wiersinga W. M. Graves' ophthalmopathy / W. M. Wiers-inga // Thyroid International. — 1997. — № 3. — P. 278.