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Young Ji Lee, Sang Yeul Lee, Helen Lew, Jin Sook Yoon; Clinical and Biochemical Characteristics of Thyroid-Associated Ophthalmopathy in Korean Populations using VISA and Fat/Muscle Typing. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5909.
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To determine the clinical characteristics of thyroid-associated ophthalmopathy (TAO) in Korean populations using Vision, Inflammation, Strabismus, and Appearance (VISA) classification and fat/muscle typing by computed tomography (CT) imaging, and to correlate the levels of serum thyroid-stimulating hormone (TSH) receptor autoantibodies (TRAbs) with TAO activity/severity scores.
A retrospective cross-sectional study with a total of 202 consecutive TAO patients (62 males and 140 females) in outpatient clinics of the Department of Ophthalmology, Yonsei University, and CHA University from June 2011 to February 2012 using VISA classification and CT imaging. Ninety-eight patients of 202 Patients were analyzed to investigate an association between serum TRAbs and clinical manifestations.
During the study period, there were four patients with (2.0%) optic neuropathy, 39 (19.3%) with active inflammation, 59 (29.2%) with diplopia, 69 (34.2%) with ocular motility restriction, 109 (54.0%) with lid retraction, 97 (48.0%) with proptosis over 18 mm, 43 (21.3%) with epiphora, 45 (22.3%) with foreign body sensation, and 33 (16.4%) with corneal damage. Of the 157 patients in whom orbital CT was taken, 44 (28.0%) patients were classified as fat predominant, 60 (38.2%) as muscle predominant, and 25 (15.9%) as combined fat and muscle predominant. Patients with optic neuropathy had higher titers of TSI (766.5 ± 198.6%) than patients without (411.5 ± 215.7%) (P = 0.006). Patients with inflammatory scores over 3, presence of lid swelling, and ocular pain showed 100% positivity of TSI. The TSI titer was significantly higher in patients with conjunctival injection and lid swelling than in patients without (539 ± 227.4% vs 363.2 ± 199.8%, p < 0.001; 509.7 ± 217.1% vs 352.0 ± 207.7%, p = 0.001, respectively).
The most common clinical manifestation of TAO was lid retraction (54.0%). A muscle predominant type was most commonly found (38.2%). TSI titer or positivity was strongly associated with severity/activity of TAO compared with TBII. Only inflammatory scores predicted TSI levels. Of the inflammatory components, both conjunctival injection and lid swelling were significant predictors for TSI level.
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