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: ObjectiveTo determine whether long-term improvement could be observed after orbital radiotherapy for Graves’ disease; in addition, to evaluate ancillary treatments needed for those who have received radiotherapy, to search for late-emerging adverse consequences of radiotherapy, and to relate orbital changes to serum levels of thyroid-stimulating immunoglobulin (TSI).: DesignThree-year follow-up of noncomparative interventional case series.: ParticipantsForty-two patients.: InterventionAll patients had received orbital radiotherapy within 6 months of study entry. Twelve months after study entry, patients were free to select any additional treatment for their ophthalmopathy.: Main outcome measuresNeed for surgery, steroid therapy, volume of extraocular muscles and fat, proptosis, area of diplopia fields and range of extraocular muscle motion, volume changes after decompression and correlations of eye findings with serum TSI levels, retinal status.: ResultsHalf of the patients elected to have a surgical procedure on their eyes or orbits. Among patients who were not decompressed, we found only slight improvement in some of the main outcome measures. TSI did not positively correlate with baseline status or with any observed change in major outcome measures. After orbital decompression, the volumes of both muscle and fat increase, but bony orbital volume increases more and proptosis diminishes. Retinal microvascular abnormalities consistent with radiation retinopathy developed de novo in five eyes of three patients within 3 years of radiation therapy.: ConclusionsIn this 3-year uncontrolled follow-up phase, limited evidence for a clinically significant improvement was observed, which may be the result of treatment or of natural remission. In either case, the changes are of little clinical significance. Because it is neither effective nor innocuous, radiotherapy does not seem to be indicated for treatment of mild to moderate ophthalmopathy. [Copyright &y& Elsevier]

: PurposeTo evaluate intraobserver reliability and interobserver reliability of a computer-based digital image measurement of eyelid position in Graves'' ophthalmopathy and to compare digital image measurement with clinical measurement.: DesignCross-sectional study.: ParticipantsEighty-four eyes of 42 patients with mild to moderate bilateral Graves'' ophthalmopathy.: MethodsDigital images were created from 35-mm color slides of both eyes of participants and projected onto a 15-inch flat-screen computer monitor. Three observers (2 oculoplastic surgeons and 1 ophthalmology resident) independently recorded eyelid fissure height, margin–reflex distance, and inferior scleral show for each eye.: Main outcome measuresIntraobserver reliability and interobserver reliability of eyelid parameter measurements, as described by the intraclass correlation coefficient (ICC) and Bland–Altman plots. Agreement between digital image measurements of the investigators and clinical measurements taken on the same day as the photographs also was assessed.: ResultsExcellent intraobserver agreement was found for the measurement of all eyelid parameters for all 3 investigators (ICC range, 0.93–0.99). Interobserver agreement for all eyelid parameters was also excellent for all investigators (ICC, 0.86–0.97). Agreement between the photographic and clinical measurements for eyelid parameters was fair to moderate (ICC range, 0.38–0.62).: ConclusionMeasurement of several eyelid parameters in Graves'' ophthalmopathy patients from computer-based digital images is reliable. Associations between photographic and clinical measurements for all parameters are weaker. Relative to clinical measurements, the photographic technique offers the advantages of potential for masking and ease of transmission that might be useful in clinical trials. [Copyright &y& Elsevier]

: PurposeTo review demographic characteristics, clinical features, and long-term outcomes of patients with optic neuropathy of Graves disease after transantral orbital decompression.: DesignRetrospective analysis of noncomparative interventional case series; long-term follow-up by questionnaire.: MethodsMedical record data (preoperative and postoperative assessments) were collected from patients who had transantral orbital decompression to treat Graves optic neuropathy. Responses to two follow-up questionnaires concerning patient satisfaction were evaluated. Statistical analysis (reflected as P values) compared preoperative and early postoperative (≤182 days) data.: ResultsBetween November 1969 and May 1989, 215 patients underwent transantral orbital decompression for Graves optic neuropathy. In 205 eyes with visual acuity of 20/40 or worse before decompression, visual acuity improved by 3 Snellen lines or more in 110 (54%) (P < .001). Of 291 eyes with visual field defects preoperatively, 120 (41%) had resolution, and 126 (43%) had improvement postoperatively (P < .001). Proptosis was reduced in 350 eyes by 4.4 ± 2.3 mm (mean ± SD) (P < .001). In 104 eyes, disk edema resolved in 72 (69%) and improved in 28 (27%). Responses to questionnaires mailed in 1990 and 2000 showed that 76% and 88% of respondents, respectively, were subjectively satisfied with the results of orbital decompression.: ConclusionsTransantral orbital decompression appeared to be effective in treating optic neuropathy of Graves disease. Patient satisfaction was high at 10-year and 20-year follow-up. [Copyright &y& Elsevier]

Purpose: To compare measurements of proptosis obtained by clinicians and computed tomography.Design: Cohort study.Methods: In a prospective randomized study of orbital radiotherapy for Graves' ophthalmopathy, measurements of proptosis were made on the same visit by an endocrinologist and an ophthalmologist using the Krahn exophthalmometer and by a technician using orbital computed tomography (CT) scans taken with head fixation to minimize position artifact.Results: Both clinical observers recorded proptosis measurements that were greater by 0.6 to 1.6 mm than those observed on the CT scan. This discrepancy resulted in part from the clinical measurements being made to the anterior corneal surface, whereas the CT measurements were made to the posterior corneal surface (a difference of approximately 0.5 mm). The aggregated observations of the clinicians did not vary significantly from each other but wide discrepancies (as much as 5 mm) were noted between single measurements made on the same patient and on the same day by different clinicians.Conclusions: The degree of variance observed in clinical measurements emphasizes the importance of defining reproducibility of the measurement techniques in prospective studies of therapeutic efficacy in patients with Graves' ophthalmopathy. The systematic difference between CT and clinical measurements of proptosis should be noted when results of clinical trials are compared. [ABSTRACT FROM AUTHOR]