This cross-sectional study included 78 adult patients who were recruited from the Department of Ophthalmic Plastic and Reconstructive Surgery. A detailed evaluation, including data on demographics and systemic and ocular history, was noted for all patients. Written informed consent was obtained from all patients. The study followed the tenets of the Declaration of Helsinki and was approved by the University of Health Sciences Hamidiye Scientific Research Ethics Committee (register number 21/11).
The patients’ diagnosis of TAO was based on the criteria of the European Group on Graves’ Orbitopathy (EUGOGO) Consensus Statement (18 (link),19 (link)). According to EUGOGO classification, all patients have mild Graves ophthalmopathy, that is, lid retraction <2 mm, mild soft tissue involvement, exophthalmos <3 mm, no diplopia or transient diplopia, and exposure keratopathy responsive to lubrication. Furthermore, thyroid-associated ophthalmopathy activity was defined using the clinical activity score (CAS) (20 (link)). In this study, all the patients who have normal thyroid function tests and with CAS s below 3 for 6 months were included in the study. On the other hand, in patients in the active stage of TAO with CAS ≥3, the presence of a difference in proptosis of more than 2 mm between the eyes, optic neuropathy, corneal ulcers, and any restrictions in the ductions, and those under current or previously systemic corticosteroid therapy or with a history of orbital surgery or radiation treatment were considered not eligible for this study. In addition, patients with high blood pressure (systolic pressure >140 mmHg or diastolic pressure >90 mmHg), cardiovascular disease, and diabetes, refractive error more than ±6 diopters and had EDI-OCT with poor image quality, which might affect the choroidal measurements, were also excluded.
Only one eye was selected in eligible patients with inactive TAO. If the involvement was unilateral, the involved eye was included, whereas, in the case of bilaterality, the selection of the eye to be examined was random. In the healthy control group, right eye was included in the study.
An ophthalmological evaluation consisted of the measurement of best-corrected visual acuity (BCVA), intraocular pressure measurement with a Goldmann applanation tonometer, a slit-lamp biomicroscopic examination of the anterior segment, and dilated fundus examination for all the participants. Axial length measurements were taken with IOL Master optical biometry (Zeiss Meditec AG, Jena, Germany). The same examiner, who was skilled at Hertel exophthalmometry, measured the proptosis.
Imaging of the choroid was performed after pupil dilation with 1% topical tropicamide (Tropamid Fort 1%, Bilim Pharmaceuticals, Istanbul, Türkiye), using the EDI mode of OCT-imaging device (Spectralis Heidelberg HRA + OCT, Heidelberg Engineering, Germany).
The patients’ diagnosis of TAO was based on the criteria of the European Group on Graves’ Orbitopathy (EUGOGO) Consensus Statement (18 (link),19 (link)). According to EUGOGO classification, all patients have mild Graves ophthalmopathy, that is, lid retraction <2 mm, mild soft tissue involvement, exophthalmos <3 mm, no diplopia or transient diplopia, and exposure keratopathy responsive to lubrication. Furthermore, thyroid-associated ophthalmopathy activity was defined using the clinical activity score (CAS) (20 (link)). In this study, all the patients who have normal thyroid function tests and with CAS s below 3 for 6 months were included in the study. On the other hand, in patients in the active stage of TAO with CAS ≥3, the presence of a difference in proptosis of more than 2 mm between the eyes, optic neuropathy, corneal ulcers, and any restrictions in the ductions, and those under current or previously systemic corticosteroid therapy or with a history of orbital surgery or radiation treatment were considered not eligible for this study. In addition, patients with high blood pressure (systolic pressure >140 mmHg or diastolic pressure >90 mmHg), cardiovascular disease, and diabetes, refractive error more than ±6 diopters and had EDI-OCT with poor image quality, which might affect the choroidal measurements, were also excluded.
Only one eye was selected in eligible patients with inactive TAO. If the involvement was unilateral, the involved eye was included, whereas, in the case of bilaterality, the selection of the eye to be examined was random. In the healthy control group, right eye was included in the study.
An ophthalmological evaluation consisted of the measurement of best-corrected visual acuity (BCVA), intraocular pressure measurement with a Goldmann applanation tonometer, a slit-lamp biomicroscopic examination of the anterior segment, and dilated fundus examination for all the participants. Axial length measurements were taken with IOL Master optical biometry (Zeiss Meditec AG, Jena, Germany). The same examiner, who was skilled at Hertel exophthalmometry, measured the proptosis.
Imaging of the choroid was performed after pupil dilation with 1% topical tropicamide (Tropamid Fort 1%, Bilim Pharmaceuticals, Istanbul, Türkiye), using the EDI mode of OCT-imaging device (Spectralis Heidelberg HRA + OCT, Heidelberg Engineering, Germany).
