Introducing the role of OCT and OCTA in Graves orbitopathy.
On the 13th of October 2018 more then 250 ophthalmologists and endocrinologists were present in Bucharest for an intensive multidisciplinary Graves orbitopathy course with the intention on implementing EUGOGO protocol in Romania and introducing the role of OCT and OCTA in this pathology.
There were exceptional lecturers in this course: Prof. dr. Poiana - endocrinology, dr. Cosmin Giulea - top 3 best thyroid surgeons in Romania, dr. Emilia Diaconu - orbital imaging, pneumologist dr. Claudia Valcu, psychologist Carmen Sendriuc, Phd dr. Andreea Ciubotaru - president of pediatric ophthalmologic society, Phd dr. Sinziana Istrate - one of best opthalmologic surgeons and ocular surface specialists, Phd dr. Violeta Bojinca and Phd dr.Carina Mihai (Zurich)- reumathologists, Phd dr. Mihai-Teodor Georgescu - radiotherapy, dr. Bianca Laslau - young oculoplastic surgeon, dr. Luminita Teodorescu - one of Romanian best strabismus surgeons; there was live from Miami USA - webinar with prof. dr. Dan Georgescu - best oculoplastic surgeon in our country. From Serbia participated internationally renown oculoplastic surgeon prof. dr. Knezevic Miroslav.
The novelty of the course came from dr. Catalina Dumitrescu who presented for the audience what extraordinary advantage could represent the use of OCT.
The importance of early diagnosis, closely monitoring and rapid treatment of complications are essential in Graves orbithopaty and OCT is the best partner for a doctor in achieving the best medical care. The patient with G.O. presents serious orbital congestion which could be detected very early during the evolution of disease by EDI- OCT which shows an early thickening of choroid; more then that the choroidal thickening detected in these patients is related with the level of proptosis. The effect of orbital congestion is producing in many cases compressive optic neuropathy (30% subclinical DON); optic nerve could be also affected by the stretching effect of proptosis or the higher level of endothelin 1 found in Graves patiens - we could detect all of these changes by scanning with OCT pRNFL or macula scan (analyzing ganglion cell layer). Also we could monitor during all duration of disease the effect of disease and treatments on noble tissues. OCT has the power in detecting early the most feared complication: dysthyroid optic neuropathy. OCT has also the ability to differentiate acute DON from normal healthy persons and chronic DON. The good news came from OCTA because it is able to detect the macular congestion with increase of micro-vessels density and peripapillary vessel density reduction in cases with loss of neuronal fibers(DON) so in the future we can use OCTA for these patients.
There is a prognosis use of OCT in preoperative of DON because we could analyse OCT results to present to the patient the postoperative prognosis depending on its results: a good pRNFL preoperative means a good postoperative visual recovery even in the presence of a bad visual field.
All this details about OCT and OCTA role in Graves orbithopaty were discussed and this update in ocular imaging seemed to be very well received by participants. It is to be expected that the future standard protocols for diagnosis and monitoring Graves orbitopathy patients will include ocular imaging.