Slobodianiuk A. S., Chepurnyi Yu. V., Romanova A. Yu., Petrenko O. V., Kopchak A. V

PERSONALIZED APPROACH TO THE TREATMENT OF ENDOCRINE ORBITOPATHY BASED ON A DIGITAL PROTOCOL AND EVALUATION OF ITS CLINICAL EFFECTIVENESS

---

Show/Download

About the author:

Slobodianiuk A. S., Chepurnyi Yu. V., Romanova A. Yu., Petrenko O. V., Kopchak A. V

Heading:

DENTISTRY

Type of article:

Scientific article

Annotation:

Endocrine orbitopathy (EO) is one of the most common complications of Graves' disease and is characterised by inflammatory and fibrotic changes in the orbital structures. Traditional approaches to surgical treatment do not always take into account the individual anatomical features of patients, which limits clinical effectiveness and can lead to complications. The aim of the study was to evaluate the clinical efficacy of a personalised approach to surgical treatment of EO based on a digital protocol that includes virtual planning, volumetry and the manufacture of navigation surgical templates (NSTs). A prospective cohort study was conducted, which included 35 patients with EO, divided into a main group (using a personalised approach, computer modelling methods, and surgical navigation templates) and a control group (traditional technique). All patients underwent multispiral CT with subsequent 3D modelling and stratification of the disease form. The main criteria for evaluating effectiveness were indicators of exophthalmos, lagophthalmos, diplopia, and hypoesthesia. Both methods provided a significant reduction in exophthalmos and lagophthalmos. The personalised approach demonstrated a considerable reduction in diplopia (p=0.027) and the frequency of hypoesthesia (p=0.014), which are the main complications of orbital decompression. The use of a personalised digital protocol in the treatment of EO provides higher clinical efficacy, a reduction in the frequency of complications and an improvement in the quality of life of patients, confirming the feasibility of its implementation in clinical practice.

Tags:

Bibliography:

1. Douglas RS, Naik V. Thyroid Eye Disease. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK582134/.
2. Wiersinga WM. Clinical review: Thyroid-associated ophthalmopathy. J Clin Endocrinol Metab. 2009;94(5):1681-6. DOI:10.1210/jc.2008-2582.
3. Ludgate M, Baker G. Unlocking the immunological mechanisms of orbital inflammation in thyroid eye disease. Clin Exp Immunol. 2002;127(2):193-8. DOI: 10.1046/j.1365-2249.2002.01792.x.
4. Brent GA. Clinical practice. Graves’ disease. N Engl J Med. 2012;367(25):2459-66. DOI: 10.1056/NEJMcp1209691.
5. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726-38. DOI: 10.1056/NEJMra0905750.
6. Perros P, Hegedüs L, Bartalena L, Marcocci C, Kahaly GJ, Baldeschi L, et al. Graves’ orbitopathy as a rare disease in Europe: a European Society of Endocrinology survey. Eur J Endocrinol. 2021;185(3):391-400. DOI: 10.1530/EJE-21-0386.
7. Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, et al. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 2008;158(3):273-85. DOI: 10.1530/EJE-07-0666.
8.  Currò N, Covelli D, Vannucchi G, Campi I, Pirola G, Simonetta S, et al. Therapeutic outcomes of high-dose intravenous steroids in the treatment of severe and active Graves’ orbitopathy: a retrospective study. Endocrine. 2014;47(3):838-43. DOI: 10.1007/s12020-014-0236-1.
9.  Costan VV, Ciocan-Pendefunda CC, Ciofu ML, Boisteanu O, Timofte DV, Gheorghe L, et al. Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy. Graefes Arch Clin Exp Ophthalmol. 2020;258(10):2313-20. DOI:10.1007/s00417-020-04807-4.
10. Hsieh MW, Hsu CK, Kuo PC, Chang HC, Chen YH, Chien KH. Factors Predicting the Success of Combined Orbital Decompression and Strabismus Surgery in Thyroid-Associated Orbitopathy. J Pers Med. 2022;12(2):186. DOI: 10.3390/jpm12020186.
11.  Brożek-Mądry E, Jurek-Matusiak O, Krzeski A. Postsurgical complications in orbital decompression for thyroid eye disease. B-ENT. 2022. DOI: 10.5152/B-ENT.2022.21708.
12.  Sellari-Franceschini S, Dallan I, Bajraktari A, Fiacchini G, Nardi M, Rocchi R, et al. Surgical complications in orbital decompression for Graves’ orbitopathy. Acta Otorhinolaryngol Ital. 2016;36(4):265-74. DOI: 10.14639/0392-100X-1082.
13.  Regensburg NI, Kok PHB, Zonneveld FW, Baldeschi L, Saeed P, Wiersinga WM, et al. A new and validated CT-based method for the calculation of orbital soft tissue volumes. Invest Ophthalmol Vis Sci. 2008;49(5):1870-5.
14. Bartalena L, Kahaly GJ, Baldeschi L, Dayan CM, Eckstein A, Marcocci C, et al. The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy. Eur J Endocrinol. 2021;185(4):G43-67. DOI:10.1530/EJE-21-0479.
15.  Barrett L, Glatt H, Burde RM, Gado M. Computed tomography in thyroid eye disease: Use of the muscle index to predict diplopia. Am J Neuroradiol. 1988;9(4):733-7.
16. Nishida Y, Tian S, Isberg B, Hayashi O, Tallstedt L, Lennerstrand G. Significance of orbital fatty tissue for exophthalmos in thyroid associated ophthalmopathy. Graefes Arch Clin Exp Ophthalmol. 2002;240:515-20. DOI: 10.1007/s00417-002-0498-3.
17.  Slobodianiuk AS, Prusak OI. Comparative analysis of volumetric characteristics of orbital soft tissues in patients with endocrine orbitopathy using computer modeling. Arch Ukr Ophthalmol. 2024;12(1):49-56. DOI: 10.22141/2309-8147.12.1.2024.352OUCI.
18.  Sung YS, Chung CM, Hong IP. The correlation between the degree of enophthalmos and the extent of fracture in medial orbital wall fracture left untreated for over six months: A retrospective analysis of 81 cases. Arch Plast Surg. 2013;40(4):335-40. DOI: 10.5999/aps.2013.40.4.335.
19.  Jellema HM, Braaksma-Besselink Y, Limpens J, von Arx G, Wiersinga WM, Mourits MP. Proposal of success criteria for strabismus surgery in Graves’ orbitopathy: a systematic literature review. Acta Ophthalmol. 2015;93(7):601-9. DOI:10.1111/aos.12717.
20.  Terwee CB, Gerding MN, Dekker FW, Prummel MF, Wiersinga WM. Development of a disease specific quality of life questionnaire for patients with Graves’ ophthalmopathy: the GO-QOL. Br J Ophthalmol. 1998;82(7):773-9. DOI:10.1136/bjo.82.7.773.
21.  Thornton J, Kelly SP, Harrison RA, Edwards R. Cigarette smoking and thyroid eye disease: a systematic review. Eye (Lond). 2007;21(9):1135-45. DOI: 10.1038/sj.eye.6702603.
22.  Kamer L, Noser H, Kirsch E, Hammer B. Anatomy-based surgical concepts for individualized orbital decompression surgery in Graves orbitopathy. II. Orbital rim position and angulation. Ophthal Plast Reconstr Surg. 2012;28(4):251-5. DOI:10.1097/IOP.0b013e31824ddbfd.
23.  Al-Qadi M, Hussain A. Influence of orbital decompression on upper eyelid retraction in Graves’ orbitopathy: a systematic review and meta analysis. Orbit. 2024;43(4):549-54. DOI: 10.1080/01676830.2023.2248621.
24.  Kontio R, Wilkman T, Mesimäki K, Chepurnyi Y, Asikainen A, Haapanen A, et al. Automated 3-D computer-aided measurement of the bony orbit: Evaluation of correlations among volume, depth, and surface area. J Pers Med. 2024;14(5):508. DOI:10.3390/jpm14050508.

Publication of the article:

«Bulletin of problems biology and medicine», Issue 2,177, 540-551 pages, index UDC 616.441-008.61-06-089.8:617.76](045)

DOI:

10.29254/2077-4214-2025-2-177-540-551