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      Strabismus surgery for improving the quality of life of strabismus patients with thyroid-associated ophthalmopathy

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          Abstract

          Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease involving the ocular tissues that may require strabismus surgery treatment. Presently, little is known about the impact of strabismus surgery on the quality of life of such patients. Consequently, the aim of the present study was to explore the effect of strabismus surgery on the quality of life of strabismus patients with quiescent TAO. This was a prospective case-series study. Strabismus patients with TAO who were admitted to the First Affiliated Hospital of Guangxi Medical University for strabismus surgery from October 2011 to April 2016 were included in this study. The included patients were asked to complete the Graves’ ophthalmopathy quality of life questionnaire (GO-QOL) before strabismus surgery and 6 weeks after the surgery, respectively. Preoperative and postoperative GO-QOL scores were compared using the paired samples t-test. The correlation between strabismus surgery and the quality of life was analyzed using Spearman correlation analysis. In total, 23 patients, with a mean age of 49.04 years old, were included in the study. Compared to the preoperative GO-QOL scores, the postoperative scores of these patients for visual function (43.04 vs 73.50, P < .001) and psychosocial function (40.13 vs 72.93, P < .001) were both significantly increased. The greater the preoperative angle of misalignment of the eyes, the worse the psychosocial function ( r = −0.433, P = .039). Strabismus surgery can significantly improve the quality of life of strabismus patients with quiescent TAO.

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          Diagnostic criteria for Graves' ophthalmopathy.

          To propose criteria for the diagnosis of Graves' ophthalmopathy. We reviewed the evolution of nomenclature describing Graves' ophthalmopathy. and the diagnostic schema used in key published reports. A laboratory test or clinical finding pathognomonic for Graves' ophthalmopathy currently is not available or recognized. Extant diagnostic criteria may exclude appropriate cases. Graves' ophthalmopathy is considered to be present if eyelid retraction occurs in association with objective evidence of thyroid dysfunction or abnormal regulation, exophthalmos, optic nerve dysfunction, or extraocular muscle involvement. The ophthalmic signs may be unilateral or bilateral, and confounding causes must be excluded. If eyelid retraction is absent, then Graves' ophthalmopathy may be diagnosed only if exophthalmos, optic nerve involvement, or restrictive extraocular myopathy is associated with thyroid dysfunction or abnormal regulation and if no other cause for the ophthalmic feature is apparent.
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            Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach.

            Patients with serious inflammatory Graves' ophthalmopathy should be treated with anti-inflammatory drugs or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately. It is often difficult, however, to distinguish inflammatory from non-inflammatory Graves' disease. We therefore present a simple clinical classification here to differentiate between these two conditions. This classification is based on the classical signs of inflammation--pain, redness, swelling, and impaired function. After two consecutive clinical examinations an 'activity score' can be determined, ranging from 0 to 10 points. In a retrospective study testing the efficacy of this classification we found that patients with an activity score of 3 or more at the beginning of therapy responded well to anti-inflammatory drugs, while those with a lower activity score mostly did not. Comparing the pretreatment activity score with the degree of enlargement of the extraocular muscles on the CT scan, we found a significant correlation between these two parameters: the higher the activity score, the more the enlargement of the muscles. We conclude that this classification facilitates the proper selection of patients for treatment.
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              Psychological implications of Graves' orbitopathy.

              Patients with thyroid eye disease, Graves' orbitopathy (GO), often appear distressed and it is likely that features of the condition such as disturbances in visual function, orbital discomfort and alterations in facial appearance can impart significant psychological morbidity upon the patient, which in turn can be detrimental to their quality of life. When considering the psychological impact of GO, two elements of the disease are important. The disfiguring changes to the eyes and face can have a direct effect upon psychological health, while physical aspects of the disease such as altered visual acuity, diplopia, orbital pain and lacrimation may influence psychological function as a secondary phenomenon, due to interference with daily living. Evidence appears to confirm the anecdotal impression of many clinicians dealing with GO patients that the prevalence of psychological morbidity in this patient group is high. A 'biopsychosocial' approach to care that addresses biological and psychosocial functioning as major determinants of health is an appropriate strategy when treating patients with GO.
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                Author and article information

                Contributors
                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MD
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                01 September 2023
                01 September 2023
                : 102
                : 35
                : e34778
                Affiliations
                [a ] Department of Ophthalmology, Wuming School of Clinical Medicine of Guangxi Medical University, Wuming Hospital of Guangxi Medical University, Nanning, China
                [b ] Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
                Author notes
                [* ]Correspondence: Jinmao Chen, Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning 530021, Guangxi, China. (e-mail: sportscjm@ 123456163.com ).
                Author information
                https://orcid.org/0009-0002-1226-9560
                Article
                00067
                10.1097/MD.0000000000034778
                10476816
                37657062
                620c43ed-ef63-4711-ad1f-160b0c75906f
                Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

                History
                : 27 May 2023
                : 25 July 2023
                : 26 July 2023
                Categories
                5800
                Research Article
                Observational Study
                Custom metadata
                TRUE

                graves’ ophthalmopathy quality of life questionnaire,life quality,strabismus surgery,thyroid-associated ophthalmopathy

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