Assessment of Clinical Signs, Retinal Nerve Fiber Layer and Central Macular Thickness in Patients with Graves Ophthalmopathy

Abstract

Purpose: to determine clinical signs, retinal nerve fiber layer and central macular thickness in patients with Graves ophthalmopathy

Objectives: To determine the Clinical Activity Score, best visual acuity, intraocular pressure and exophthalmos in patients with Graves’ Ophthalmopathy. To determine Retinal Nerve Fiber Layer (RNFL) and Central Macular Thickness (CMT) by Optical Coherent Tomography (OCT). To determine the relationship between CAS, best visual acuity, intraocular pressure, exophthalmos and RNFL, central macular thickness.

Methods: The retrospective study was done at Lithuanian University of Health sciences Kaunas Clinic of Eye diseases outpatient department. We reviewed the electronic medical records of all patients with Graves‘ ophthalmopathy seen at the Clinic of Eye diseases between 2021 and 2024, selecting 62 total patients (124 eys). The median age was 49.3 years, ranging from 18.4 years to 74.5 years. All patients had undergone a full ophthalmologic exam, including Best Corrected Visual Acuity (BCVA), Clinical Activity Score (CAS), exophthalmometry with Hertel mirror exophthalmometer, dilated fundus imaging, Schiotz tonometry and OCT imaging (RNFL and CMT).

All data were processed using statistical analysis software IBM SPSS 29.0. A statistical significance level of p<0.05 was considered.

Results: The mean of CAS of patients was 3,22 ± 0.43, (range 0-7). The mean BCVA was 0.84 ± 0.19. Intraocular eye pressure ranged form 12.3 to 23.5 mmHg, with a mean of 16.83 ± 2.75 mmHg. Exophthalmos results ranged form 13.9 to 23.3 mm. The mean was 18.26 ± 2.07 mm. The mean of RNFL thickness was 96.84 ± 11.27μm and central macular thickness was 271.43± 22.82μm. A statistically significant correlation was found between BCVA and RNFL, CMT thickness (r=0.376, p=0.001, r=0.258, p=0.026, respectively). A statistically significant negative correlation was found between CAS and RNFL, CMT (r=-0.406, p<0.001; r=-0.233, p=0.046, respectively). These data indicate that the lower the visual acuity and the higher the disease activity, the thinner the RNFL and CMT.

A negative significant correlation was between IOP, exophthalmos and RNFL (r=-0.348, p=0.002; r=-0.287, p=0.013, respectively). This shows that the greater IOP and exophthalmos the thinner RNFL. However, there was no significant relationships between IOP, exophthalmos and CMT (r=-0.14, p=0.235; r=-0.2, p=0.088, respectively).

Conclusion: A statistically significant correlation was found between Clinical activity score, best corrected visual acuity, intraocular pressure, exophthalmos and RNFL in patients with GO. CAS and BCVA were significantly correlated with central macular thickness. There was no significant relationship between IOP, exophthalmos and CMT. Our study suggests that OCT is useful in diagnosing, monitoring and predicting vision in patients with compressive optic neuropathy in GO.