Teprotumumab for Thyroid Eye Disease-related Strabismus

Abstract

Purpose: To assess and quantify teprotumumab's effect on thyroid eye disease-related strabismus by change in measured horizontal and vertical deviations and change in extraocular motility.

Methods: We reviewed a series of patients with thyroid eye disease-related strabismus treated with teprotumumab. Exclusion criteria included age under 18 years, strabismus of alternate etiology, or thyroid eye disease-related reconstructive surgery during the treatment course. Primary outcomes were absolute (prism diopters) and relative (%) differences in horizontal and vertical deviations in primary position at distance, as well as change in ductions of the more affected eye. Secondary outcomes included incidence and timing of strabismus surgery postteprotumumab.

Results: Thirty-one patients were included, with mean age 63 years and thyroid eye disease duration 10 months. After teprotumumab, there was 6 prism diopters (39%) mean reduction in vertical deviation ( p < 0.001), without significant change in mean horizontal deviation ( p = 0.75). Supraduction, abduction, adduction, and infraduction significantly improved in the more restricted eye ( p < 0.01, p < 0.01, p = 0.04, and p = 0.01, respectively). Thirty-five percent of patients underwent strabismus surgery posttreatment, at an average 10 months after last infusion.

Conclusions: Teprotumumab produced a statistically significant reduction in vertical but not horizontal strabismus angles in primary position at distance. Extraocular motility in all 4 ductions also improved. A substantial minority of patients still required strabismus surgery following teprotumumab.

Figure 1:

Vertical deviations pre-, mid-, and post-teprotumumab with multivariable mixed effects model controlling for age, sex, TED phase, and smoking history with mean and its 95% confidence interval overlaid (N=17).

Figure 2:

TED with left hypotropia (A) in primary position with improvement in deviation post teprotumumab (B).

Figure 3:

TED with left hypotropia (A) with improvement in vertical deviation in sursumversion (top) and primary position (bottom) post- teprotumumab (B).

Figure 4:

Horizontal deviations pre-, mid, and post-teprotumumab with multivariable mixed effects model controlling for age, sex, TED phase, and smoking history with mean and its 95% confidence interval overlaid (N=19).

Figure 5:

Changes in ductions (post versus pre teprotumumab) in the more affected eye (N=31).