The authors present a retrospective medical case review which explored the patterns of strabismus and surgical outcomes in individuals with thyroid eye disease (TED) treated with teprotumumab. A total of 28 cases treated were identified from a 10-year period. This group of cases were compared to surgical outcomes of a previously published cohort of individuals with TED who had not received teprotumumab. The study reported that teprotumumab significantly reduced vertical deviations and improved eye movement limitations, although horizontal deviations were largely unchanged. Despite medical treatment, all cases continued to experience diplopia, with the majority (n=27) requiring prism correction, strabismus surgery, or both. Among the 15 individuals who underwent surgery, 73% were left diplopia-free in primary position and 67% achieved ‘successful’ (<5Δ vertical and <10Δ horizontal deviation in primary position at distance fixation) alignment. The findings suggest that while teprotumumab can improve certain aspects of strabismus, particularly vertical deviations. Further, it did not eliminate the need for surgical intervention in many cases, however, the preoperative deviations were on average smaller. The comparison with a historical untreated cohort was particularly useful, demonstrating that surgical outcomes remain comparable after teprotumumab treatment. The study included detailed sensorimotor analysis and direct comparison with outcomes from the same institution and surgical team. The authors acknowledge several limitations including the retrospective methodology, small sample size, incomplete pre-treatment data for some cases and lack of a matched control group. The findings may help clinicians counsel individuals with TED regarding realistic expectations following medical treatment.
Outcomes of using teprotumumab to treat thyroid eye disease
Reviewed by Lauren R Hepworth
Strabismus patterns and surgical results in teprotumumab-treated thyroid eye disease: insights from a single-center study.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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