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      Assessment of Choroidal Vascularity in Inactive Thyroid Associated Orbitopathy

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          Abstract

          Objectives:

          The objectives of the study were to evaluate the vascular and stromal structure of the choroid in patients with inactive thyroid associated orbitopathy (TAO) by measuring choroidal vascularity index (CVI) and choroidal thickness (CT) using enhanced depth imaging (EDI) optical coherence tomography (OCT).

          Methods:

          The choroidal image was taken with EDI mode spectral domain (SD)-OCT. All scans were taken between 9.30 am and 11.30 am to avoid the diurnal variation of CT and CVI. To calculate CVI, macular SD-OCT scans were binarized using the publicly available software ImageJ and luminal area and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. Furthermore, the relation between CVI and axial length, gender, and age was evaluated.

          Results:

          This study included 78 individuals with a mean age of 51.4±7.3 years. Group 1 consisted of 44 patients with inactive stage TAO, and Group 2 consisted of 34 healthy controls. Subfoveal CT was 338.92±73.93 µm in Group 1 and 303.97±40.35 µm in Group 2 (p=0.174). The CVI significantly differed between the two groups, which was higher in group 1 (p=0.000).

          Conclusion:

          Although CT was not different between groups, CVI which is the indicator of the vascular status of the choroid, was higher in patients with TAO in the inactive stage compared with healthy control subjects.

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          Most cited references40

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          Graves' Disease.

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            The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

            Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.
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              Choroidal vascularity index as a measure of vascular status of the choroid: Measurements in healthy eyes from a population-based study

              The vascularity of the choroid has been implicated in the pathogenesis of various eye diseases. To date, no established quantifiable parameters to estimate vascular status of the choroid exists. Choroidal vascularity index (CVI) may potentially be used to assess vascular status of the choroid. We aimed to establish normative database for CVI and identify factors associated with CVI in healthy eyes. In this population-based study on 345 healthy eyes, choroidal enhanced depth imaging optical coherence tomography scans were segmented by modified image binarization technique. Total subfoveal choroidal area (TCA) was segmented into luminal (LA) and stromal (SA) area. CVI was calculated as the proportion of LA to TCA. Linear regression was used to identify ocular and systemic factors associated with CVI and subfoveal choroidal thickness (SFCT). Subfoveal CVI ranged from 60.07 to 71.27% with a mean value of 65.61 ± 2.33%. CVI was less variable than SFCT (coefficient of variation for CVI was 3.55 vs 40.30 for SFCT). Higher CVI was associated with thicker SFCT, but not associated with most physiological variables. CVI was elucidated as a significant determinant of SFCT. While SFCT was affected by many factors, CVI remained unaffected suggesting CVI to be a more robust marker of choroidal diseases.
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                Author and article information

                Journal
                Beyoglu Eye J
                Beyoglu Eye J
                Beyoglu Eye Journal
                Kare Publishing (Turkey )
                2459-1777
                2587-0394
                2023
                01 March 2023
                : 8
                : 1
                : 38-44
                Affiliations
                [1]Department of Ophthalmology, University of Health Sciences Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Türkiye
                Author notes
                Address for correspondence: Seren Pehlivanoglu, MD. Department of Ophthalmology, University of Health Sciences Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Türkiye Phone: +90 212 251 59 00 E-mail: srnmert@ 123456hotmail.com
                Article
                BEJ-8-38
                10.14744/bej.2022.04900
                9993418
                36911212
                f95f7edf-a139-4fba-bdbd-f044e4198ac4
                Copyright: © 2023 by Beyoglu Eye Training and Research Hospital

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                : 01 July 2022
                : 15 September 2022
                : 09 October 2022
                Categories
                Original Article

                choroidal thickness,choroidal vascularity index,edi-optical coherence tomography,thyroid-associated ophthalmopathy

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