Strabismus patterns and surgical results in teprotumumab-treated thyroid eye disease: insights from a single-center study

Abstract

Purpose: To examine strabismus patterns and surgical outcomes in patients with teprotumumab-treated thyroid eye disease (TED).

Methods: The medical records of TED patients with strabismus who were treated with teprotumumab from 2014 to 2023 were reviewed retrospectively. Strabismus surgery sensorimotor outcomes in this cohort were also compared with those of a prior study of teprotumumab-untreated patients at the same institution.

Results: A total of 28 teprotumumab-treated patients (mean age, 62.3 years; 19 females [68%]) were identified and included. No significant difference in the mean magnitude of horizontal strabismus at distance was observed in 9 patients who had sensorimotor measurements pre- and post-teprotumumab (30.4^Δ ± 26.0^Δ vs 23.1^Δ ± 30.9^Δ [P = 0.375]); however, vertical deviations significantly decreased after treatment (17.2^Δ ± 15.9^Δ vs 3.7^Δ ± 13.6^Δ [P = 0.023]). Post-teprotumumab, all patients (100%) had persistent diplopia; this was treated with prisms in 12 patients (43%), strabismus surgery in 11 (39%), and prisms and surgery in 4 (14%). One patient was not treated. In the surgical subgroup (n = 15), the mean interval from the last teprotumumab treatment to surgery was 16 ± 6.8 months (range, 3-30). The mean preoperative deviations at distance were 17.0^Δ ± 10.8^Δ vertically and 21.3^Δ ± 20.6^Δ horizontally. Postoperatively, mean deviations were -2.0^Δ ± 14.7^Δ vertically and 3.5 ± 8.2^Δ horizontally. After the first strabismus surgery, 73% of patients were diplopia-free, compared with 58% in our previously reported cohort of teprotumumab-untreated patients (P = 0.26), and 67% achieved motor success, compared with 69% in our previous cohort.

Conclusions: Teprotumumab did not affect the degree of horizontal strabismus, but the magnitude of vertical deviations was reduced following treatment. The present study achieved a high rate of sensory success and similar rate of motor success in teprotumumab-treated patients compared with teprotumumab-untreated patients from a 2020 study conducted at the same institution.