Alterations in retrobulbar hemodynamics in thyroid eye disease

Abstract

Abstract Purpose: To study the orbital perfusion parameters of ophthalmic artery (OA) and central retinal artery (CRA) in inactive TED and the changes following surgical decompression. Methods: Non-randomised clinical trial. 24 inactive moderate-to-severe TED orbits of 24 euthyroid cases underwent surgical decompression and examined again at 3 months. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) of OA and CRA were evaluated using color doppler imaging and normative database was established using 18 healthy controls. Results: The mean age was 39.38 +12.56 years and male: female ratio was 1: 1.18. Intraocular pressure was higher, and CRA – PSV, CRA – RI, OA – PSV, and OA – EDV were lower in TED in comparison to heathy orbits. The CRA – PSV, CRA – EDV, OA – PSV, and OA – EDV negatively correlated with proptosis and duration of thyroid disease. The area under curve of OA – PSV (95% CI:0.964-1.000, p<0.001) and OA – EDV (95% CI:0.699-0.905, p<0.001) helped in differentiating TED orbits from healthy controls, and in predicting the severity of disease. Post decompression, CRA – PSV, CRA – EDV, OA – PSV, and OA – EDV improved, with decrease in CRA – RI and OA – RI in both lipogenic and myogenic orbitopathy. Conclusions: The orbital perfusion is reduced in inactive TED. The changes in OA flow velocities can help in differentiating inactive TED from healthy orbits and progression of TED. Sequential orbital CDI of OA and CRA can serve as an objective tool for case selection and monitoring response to surgical decompression.