FRI547 Orbital Surgery In Moderate-To-Severe Graves´Ophthalmopathy: Institutional Experience
Authors: Delfino Laura , Anabela Zunino , Ilera Veronica , García Roel Valeria , Reyes Adriana , Teresa Gauna Alicia 
Published: October 2023

Abstract
Disclosure: L. Delfino: None. Z. Anabela: None. V. Ilera: None. V. García Roel: None. A. Reyes: None. A.T. Gauna: None.
Management of moderate-to-severe Graves´ophtalmopathy (GO) depends mainly on the degree of soft tissue inflammation. While immunosuppressive therapy is indicated in the active phase, orbital surgery (OS) is reserved for sequelae disease. Indication of OS during active phase is sight-threatening GO not responding to steroids. Although not a common practice, OS during active disease has been performed in our institution as a second line therapy. We aim to describe our experience in patients that underwent OS for active and inactive GO. Methods: retrospective study. Activity and severity were defined according to 2021 EUGOGO guidelines. Response to OS was classified as: adequate (improvement of GO), partial (stabilization without progression) and poor (progression of GO). Results: 32 patients underwent OS, 59.4% were women, median age 47 years (25-67), 48.4% smokers. Management of hyperthyroidism comprised antithyroid drugs in 19 cases (59.3%), radioiodine in 11 (34.4%) and thyroidectomy in 2. At the time of surgery 27 patients (84.4%) were euthyroid, 4 (12.5%) subclinical hyperthyroid and 1 (3.1%) hypothyroid. GO was inactive in 18 (56.3%) of cases and active in 14 (43.7%). All patients with active GO and 6 patients with inactive GO had been treated with weekly intravenous steroids as proposed by Kahaly or with 1 g methylprednisolone/d for 3 days. Indications for OS were rehabilitation for aesthetic/functional sequelae in 53.1%, dysthyroid optic neuropathy in 15.6%, poor response to steroids in 15.6% and others (optic nerve elongation, exposure keratopathy, ocular subluxation) in 15.6% of cases. At the time of OS 16 patients received concomitant steroids, 10 with active and 6 with inactive GO but positive anti-TSH receptor antibodies (TRAb) and risk factors. Response to treatment was considered adequate in 81.3%, stable in 12.5% and poor in 6.3% (one active and one inactive GO). Before OS TRAb were positive in 90.6% of patients. After surgery TRAb decreased in 64.3%, remained stable in 10.7% and were negative in 25% of cases. No patient with negative TRAb before OS presented positive levels after procedure. The percentage of patients with negative TRAb was significantly higher post-surgery [90.6% vs 65.6%, X2 (1) =5, p=0.025]. Evolution of TRAb was not related with concomitant use of steroids for OS. Conclusions: in our experience, response to OS was satisfactory in more than 90% of cases. In patients with active GO and inadequate response to previous intravenous steroids treatment, OS achieved favorable results in more than 80%. TRAb levels decreased or became negative in most cases, with no increments after surgery. We consider that OS can be an appropriate second-line treatment option in cases of unfavorable response to steroids and inaccessibility to other treatment modalities, and that positivity of TRAb should not be a condition to preclude OS.
Presentation: Friday, June 16, 2023