ABSTRACT
PURPOSE: Graves' orbitopathy (GO) is an autoimmune disorder leading to inflammation, adipogenesis, and fibrosis. The severity of GO can vary widely among individuals, making it challenging to predict the natural course of the disease accurately, which is important for tailoring the treatment approach to the individual patient. The aim of this study was to compare the clinical characteristics, course, treatment, and prognosis of GO patients under 50 years with older patients. METHODS: We reviewed the medical records of a random sample of 1000 patients in our GO database Essen (GODE) comprising 4260 patients at our tertiary referral center. Patients were divided into two groups: Group 1 (≤50 years) and Group 2 (>50 years). Only patients with a complete data set were included in the further statistical analysis. RESULTS: The results showed that younger patients (n = 484) presented significantly more often with mild GO (53% vs. 33%, p < 0.0001), while older patients (n = 448) were more likely to experience moderate-to-severe disease (44% vs. 64%, p < 0.0001). Older patients showed more severe strabismus, motility, and clinical activity scores (5.9 vs. 2.3 PD/310° vs. 330° both p < 0.0001, CAS: 2.1 vs. 1.7, p = 0.001). Proptosis and occurrence of dysthyroid optic neuropathy (DON) showed no significant difference between groups (both 3%). Multiple logistic regression revealed that the need for a second step of eye muscle surgery was most strongly associated with prior decompression (OR = 0.12, 95% CI: 0.1-0.2, p < 0.0001) followed by orbital irradiation and age. The model showed good fitness regarding the area under the curve (AUC = 0.83). DISCUSSION: In conclusion, younger GO patients present with milder clinical features such as a lower rate of restrictive motility disorders and less pronounced inflammatory signs. Therefore, older patients tend to need more steroids, irradiation, and lid and eye muscle surgery. Still, the risk of DON and the necessity of secondary eye muscle surgery are not or only slightly associated with age, respectively.
ABSTRACT
BACKGROUND: The health sector is facing new challenges due to the impact of climate change on health. At the same time, it significantly contributes to our society's climate footprint. Hospitals producing considerable amounts of waste are an important aspect of this burden. The aim of this work was to quantify the amount of waste produced by eye surgery and, as an optimization measure, to evaluate the effect of glass separation from residual waste. MATERIAL AND METHODS: Over a 2-week period, the waste generated by eye operations in the surgical theater of our university hospital was measured. Another 2week long measurement was conducted after the initiation of glass separation from general waste. The data obtained allowed a comparison of the two periods, the type of waste (residual and recyclable) as well as the type of operation (intraocular, extraocular). Considering regional waste disposal costs, an economic comparison was also performed. RESULTS: In the first measurement period (196 operations), a total of 549.6â¯kg of waste was generated, 87% (478.3â¯kg) of which was residual waste, corresponding to 14.3 tons of total waste annually. Intraocular procedures generated on average 80% more waste than extraocular procedures: 18.1⯱ 3.9â¯kg and 11.4⯱ 4.0â¯kg, respectively, per day and theater. Separation of glass from residual waste reduced its quantity by 7.2% in the second measurement period (197 procedures). As the disposal of glass is free of charge in the city of Essen, this resulted in a small economic advantage (extrapolated to 112⯠per year). CONCLUSION: The amount of waste generated by ophthalmic surgery is substantial, with a predominant proportion of non-recyclable residual waste. Intraocular operations are the cause of the majority of the waste produced. Simple measures, such as disposing of glass separately, are helpful and inexpensive to reduce the quantity of residual waste.
