Change in Quality of Life after Orbital Decompression Surgery in Patients with Dysthyroid Ophthalmopathy

Jung Huh; Jeong Kyu Lee

doi:10.3341/jkos.2016.57.10.1514

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Huh and Lee: Change in Quality of Life after Orbital Decompression Surgery in Patients with Dysthyroid Ophthalmopathy

Original Article

J Korean Ophthalmol Soc 2016;57(10):1514-1520.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1514

Change in Quality of Life after Orbital Decompression Surgery in Patients with Dysthyroid Ophthalmopathy

Jung Huh, MD, Jeong Kyu Lee, MD, PhD

Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea

Address reprint requests to Jeong Kyu Lee, MD, PhD Department of Ophthalmology, Chung-Ang University Hospital, #102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: 82-02-6299-1666, Fax: 82-02-6298-8351 E-mail: Lk1246@hanmail.net

Received 16 June 2019 Accepted 19 September 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of orbital decompression surgery on quality of life in thyroid-associated ophthalmopathy (TAO) patients.

Methods

From August 2014 to December 2015, 80 patients diagnosed with TAO at our clinic were retrospectively analyzed. The patients were divided into 2 groups: 30 patients who underwent orbital decompression surgery and 50 patients who did not receive surgery. The Korean version of the Grave's ophthalmopathy specific quality of life (GO-QoL) questionnaire was completed by all patients. We compared questionnaire scores between groups and analyzed demographic and clinical factors affecting change in GO-QoL.

Results

The patients who underwent orbital decompression had lower mean GO-QoL score for appearance in comparison with patients without orbital decompression (p < 0.001). The mean GO-QoL score for appearance was increased from 28.8 ± 17.1 to 51.5 ± 18.8 after orbital decompression (p = 0.024). The mean GO-QoL score for visual function was not different between the patients who did not receive surgery and the orbital decompression group. The mean GO-QoL score for visual function was not changed after orbital decompression. There was a significant relation between postoperative proptosis degree and change in GO-QoL score for appearance after orbital decompression.

Conclusions

GO-QoL score for appearance was significantly improved after orbital decompression surgery, and psychological interventions should be considered to enhance the quality of life outcomes.

Keywords: Dysthyroid ophthalmopathy, Orbital decompression, Quality of life

References

1. Burch HB, Wartofsky L. Graves' ophthalmopathy: current concepts regarding pathogenesis and management. Endocr Rev. 1993; 14:747–93.

2. Bahn RS. Understanding the immunology of Graves' ophthalmopathy. Is it an autoimmune disease? Endocrinol Metab Clin North Am. 2000; 29:287–96. vi.

3. Choi YJ, Lim HT, Lee SJ, et al. Assessing Graves' ophthalmop-athy-specific quality of life in Korean patients. Eye (Lond). 2012; 26:544–51.

4. Son BJ, Lee SY, Yoon JS. Evaluation of thyroid eye disease: abdominal-of-life questionnaire (TED-QOL) in Korean patients. Can J Ophthalmol. 2014; 49:167–73.

5. Lee H, Roh HS, Yoon JS, Lee SY. Assessment of quality of life and depression in Korean patients with Graves' ophthalmopathy. Korean J Ophthalmol. 2010; 24:65–72.

6. Bartalena L, Marocci C, Bogazzi F, et al. Glucocorticoid therapy of Graves' ophthalmopathy. Exp Clin Endocrinol. 1991; 97:320–7.

7. Lyons CJ, Rootman J. Orbital decompression for disfiguring exophthalmos in thyroid orbitopathy. Ophthalmology. 1994; 101:223–30.

8. Fatourechi V, Garrity JA, Bartley GB, et al. Graves ophthalmopathy. Results of transantral orbital decompression performed primarily for cosmetic indications. Ophthalmology. 1994; 101:938–42.

9. Wickwar S, McBain H, Ezra DG, et al. The psychosocial and abdominal outcomes of orbital decompression surgery for thyroid eye abdominal and predictors of change in quality of life. Ophthalmology. 2015; 122:2568–76.e1.

10. Terwee CB, Dekker FW, Mourits MP, et al. Interpretation and validity of changes in scores on the Graves' ophthalmopathy quality of life questionnaire (GO-QOL) after different treatments. Clin Endocrinol (Oxf). 2001; 54:391–8.

11. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf). 1997; 47:9–14.

12. Terwee CB, Gerding MN, Dekker FW, et al. Test-retest reliability of the GO-QOL: a disease-specific quality of life questionnaire for patients with Graves' ophthalmopathy. J Clin Epidemiol. 1999; 52:875–84.

13. Achtsidis V, Tentolouris N, Theodoropoulou S, et al. Dry eye in Graves ophthalmopathy: correlation with corneal hypoesthesia. Eur J Ophthalmol. 2013; 23:473–9.

14. Abràmoff MD, Kalmann R, de Graaf ME, et al. Rectus extraocular muscle paths and decompression surgery for Graves orbitopathy: mechanism of motility disturbances. Invest Ophthalmol Vis Sci. 2002; 43:300–7.

15. Garrity JA, Fatourechi V, Bergstralh EJ, et al. Results of transantral orbital decompression in 428 patients with severe Graves' ophthalmopathy. Am J Ophthalmol. 1993; 116:533–47.

16. Terwee CB, Gerding MN, Dekker FW, et al. Development of a abdominal specific quality of life questionnaire for patients with Graves' ophthalmopathy: the GO-QOL. Br J Ophthalmol. 1998; 82:773–9.

17. Soeters MR, van Zeijl CJ, Boelen A, et al. Optimal management of Graves orbitopathy: a multidisciplinary approach. Neth J Med. 2011; 69:302–8.

18. Carr T, Moss T, Harris D. The DAS24: a short form of the Derriford Appearance Scale DAS59 to measure individual responses to living with problems of appearance. Br J Health Psychol. 2005; 10(Pt 2):285–98.

Figure 1.

Grave's ophthalmopathy specific quality of life (GO-QoL) scores for visual function and appearance. There was no significance difference in GO-QoL score for visual function between each groups. The patients who underwent orbital decompression had lower mean GO-QoL score for appearance in comparison with patients without orbital decompression (^* p < 0.001). The mean GO-QoL score for appearance was increased after orbital decompression (^† p = 0.024).

Table 1.

Characteristic of study population

	No-surgery group	Decompression group	p-value
Number	50	30
Sex (male/female)	18/32	12/18	0.721^*
Age (years)	34.7 ± 12.4 (16–63)	33.8 ± 11.0 (18–60)	0.693^‡
Family history of thyroid disease (n, %)	17 (34)	13 (43.3)	0.944^*
Smoker (n, %)	9 (18)	4 (13.3)	0.757^†
Duration of eye symptoms (months)	34.5 ± 40.5 (6–144)	41.9 ± 56.5 (10–180)	0.207^‡
Clinical activity score	2.2 ± 1.1	2.5 ± 1.1	0.177^‡
Exophthalmos	18.8 ± 2.2	19.8 ± 2.5	0.521^‡
Compression neuropathy (n, %)	5 (10)	2 (6.7)	0.706^†

Values are presented as mean ± standard deviation.

^* Chi-square test

^† Fisher's exact test

^‡ Unpaired t-test.

Table 2.

Factors associated with changes in quality of life (QoL) parameter after orbital decompression

		Age	Duration	CAS	Pre-op Exo	Exo change	Post-op Exo
Visual score	Pearson coefficient	–0.036	0.190	0.068	–0.048	0.195	–0.092
	p-value	0.850	0.565	0.721	0.800	0.301	0.629
Appearance score	Pearson coefficient	0.019	0.372	0.123	–0.095	0.169	–0.423
	p-value	0.922	0.067	0.081	0.617	0.372	0.020
Total QoL score	Pearson coefficient	–0.017	0.031	0.120	0.169	0.242	–0.304
	p-value	0.929	0.782	0.529	0.372	0.197	0.102

CAS = clinical activity score; Pre-op = preoperative; Post-op = postoperative; Exo = exophthalmometer.

Table 3.

Frequencies of responses from Grave's ophthalmopathy specific quality of life (GO-QoL) questionnaire

	Yes, severely limited (%)			Yes, a little limited (%)			No, not at all limited (%)
	Follow up	Decompression		Follow up	Decompression		Follow up	Decompression
	Follow up	Before	After	Follow up	Before	After	Follow up	Before	After
Visual
Riding a bicycle	4	6.7	6.7	16	26.7	20.0	58	33.3	40.0
Driving	6	6.7	6.7	24	23.3	23.3	28	23.3	23.3
Moving around the house	4	3.3	3.3	6	36.7	26.7	90	60.0	70.0
Walking outdoors	6	6.7	6.7	24	36.7	36.7	70	56.7	56.7
Reading	8	6.7	16.7	40	56.7	36.7	52	36.7	46.7
Watching TV	4	3.3	6.7	34	46.7	43.3	62	50.0	50.0
Hobbies or pastimes	6	3.3	10.0	36	53.3	43.3	58	43.3	46.7
Hindered from doing something	6	16.7	6.7	70	63.3	63.3	24	20.0	30.0
Appearance
Changed appearance	84	76.7	53.3	16	23.3	40.0	0	0.0	6.7
Stared in the streets	18	46.7	23.3	54	50.0	53.3	28	3.3	23.3
People react unpleasantly	4	30.0	3.3	46	56.7	70.0	50	13.3	26.7
Influence on self confidence	40	66.7	30.0	48	33.3	53.3	12	0.0	16.7
Socially isolated	2	16.7	6.7	30	56.7	46.7	68	26.7	46.7
Influence on making friends	20	46.7	10.0	40	40.0	56.7	40	13.3	33.3
Appear less on photos	54	70.0	23.3	36	26.7	50.0	10	3.3	26.7
Mask changes of appearance	40	63.3	33.3	38	26.7	43.3	22	10.0	23.3

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