RESUMO
Endocrine ophthalmopathy (EOP) is a severe chronic autoimmune disease associated with autoimmune thyroid pathology that leads to loss of sight, cosmetic defects and quality of life decrease. EOP is difficult to give prognosis for due to various factors affecting its course and outcome. PURPOSE: To develop a reliable and precise prognosis method for EOP activity and severity based on personalized combination of risk factors in specific patients by multidimensional linear regression modeling. MATERIAL AND METHODS: A group of 139 patients (278 orbits) with newly diagnosed EOP associated with toxic diffuse goiter was observed during 1 year by an ophthalmologist and an endocrinologist; patient examination interval was 6 months. More than 250 indices were dynamically analyzed in the course of the study. Linear regression analysis was chosen as the research method; it allowed detection of linear dependencies between dependent and explanatory variables. RESULTS: More than 600 various linear regression equations were derived that enabled prediction of EOP onset risk and development timeline, estimation of activity and/or severity of the disease, duration of active period in specific patients for the immediate and long-term outcome. From the derived models, the most reliable and safest for practical application were picked out. The present study introduces nine optimized models that can be used for patient follow-up since day one. CONCLUSION: The onset risk, progression and outcome of the disease can be determined by a combination of factors revealed in the study.
Assuntos
Doença de Graves , Oftalmopatia de Graves , Oftalmopatia de Graves/diagnóstico , Humanos , Modelos Lineares , Qualidade de VidaRESUMO
AIM: to investigate the contribution of various hemodynamic disturbances in magistral vessels to optic neuropathy (ON) progression and ocular tension changes in endocrine ophthalmopathy (EOP). MATERIAL AND METHODS: A total of 39 patients (78 eyes) with subclinical EOP (clinical activity score, CAS ≤ 2) associated with Graves' disease (n = 32, 64 eyes) or autoimmune thyroiditis (n = 7, 14 eyes) were examined. Orbit echography was performed in all patients. Blood flow was assessed with a Voluson 730 PRO ultrasound diagnostic system ("Kretz", Austria) in triplex mode (B-scan, color Doppler flow mapping in combination with pulse-wave Doppler). Thus obtained hemodynamic parameters in ophthalmic artery, central retinal artery (CRA), central retinal vein (CRV), short posterior ciliary arteries (SPCA), and long posterior ciliary arteries (LPCA) were analyzed. To reveal the role of hemodynamic disturbances in the above mentioned vessels in ON progression and eye pressure maintenance, the patients were divided into 7 groups. Only those eyes, whose peripheral indices were increased by more than 25% of normal values and diastolic blood flow decreased by not less than 25%, were selected for further study. Intraocular pressure changes were evaluated by group mean (Mmean = M ± m mmHg), optic neuropathy progression--by the difference in group mean depth (dB) and number of scotomas between the first and the last visit (6 months of observation). RESULTS: In almost all types of perfusion disturbances, the resultant chronic ocular ischemia causes a decrease in IOP. The only exception, as shown, is simultaneous involvement of CRA, SPCA, and LPCA. The level of blood flow disturbance determines the severity of qualitative and quantitative changes in eyes with EOP-associated ON. The rate of ON progression directly correlates with baseline IOP values on day zero. CONCLUSION: Long-lasting chronic impairment of blood supply of the eyeball leads to reduction in ocular tension and progression of optic neuropathy. Combined perfusion disturbances in CRA and LPCA as well as in CRA, LPCA, and SPCA can be considered a high-risk factor, while SPCA and/or LPCA involvement--a moderate-risk factor.
