![]() glaucoma, optic nerve diseases, retinal diseases, obvious media opacities, obvious strabismus). The inclusion criteria for healthy controls included: best corrected visual acuity (BCVA) better than 20/30, no ophthalmopathy except mild cataract, intraocular pressure (IOP) −3.0 D or >+2.0 D, cylindrical: >☑.5 D), evident exposure keratopathy which could affect vision, other ophthalmopathies that could affect OCT measurements (e.g. DON was diagnosed based on the followings: decreased visual acuity, relative afferent pupillary defect, abnormal colour vision (Ishihara plates), compatible VF defect, disc swelling or atrophy as well as orbital apex crowding. Mild and moderate-to-severe group were defined using the European Group on Graves’ Orbitopathy (EUGOGO) criteria. All the eyes diagnosed with TED were divided into three groups based on their severity: (1) mild group, (2) moderate-to-severe group, (3) DON group. Seventy-five TED patients and 35 healthy controls were recruited in Eye & ENT Hospital, Fudan University from January 2018 to July 2019. In this study, we evaluated the thickness of ganglion cell layer/inner plexiform layer (GCL/IPL) and RNFL in TED patients and healthy controls, and analysed the changes in different disease severities. However, the changes of RGCs thickness in different stages and severities were rarely studied. The thickness of macular retinal layer had shown to be thinner in TED patients, which might be caused by the thinning of RGCs. Retinal ganglion cells (RGCs) measurement has shown to be a useful marker in the diagnosis and monitoring of multiple optic neuropathies, and it is thought to be more sensitive than RNFL. However, the changes of RNFL thickness were not entirely consistent in previous studies because optic disc could appear as swelling, pallor or normal in different stages and severities of TED. Retinal nerve fibre layer (RNFL) thickness had been proved to decrease in TED patients who had no clinical sign of DON, which indicated structural damage might occur earlier than functional impairment. Recent years, optic coherence tomography (OCT) has emerged as a more reliable and reproducible tool for assessing the anatomy of the optic nerve. DON was always evaluated clinically in terms of visual acuity, colour vision, pupillary reaction and visual field (VF). TED is characterised by an enlargement of orbital soft tissue including extraocular muscles and orbital fat, which could lead to orbital apex compression, ischemia and optic nerve damage. While the majority of patients exhibit mild-to-moderate symptoms, about 3–7% develop vision threatening complications such as dysthyroid optic neuropathy (DON). TED demonstrates a variable clinical presentation. The natural history of TED is characterised by an active phase and followed by an inactive phase. Thyroid eye disease (TED) is the most common orbital disease, affecting 25–50% of patients with Grave’s disease. The thinning of GCL/IPL might be a strong suggestion for closer vision follow-up and earlier decompression surgery. OCT measurements of GCL/IPL and RNFL are useful to detect the early changes of optic nerve. Subclinical optic neuropathy might progress in the patients with moderate-to-severe TED. The mean GCL/IPL thickness had a significant correlation with MD ( r = 0.449, p < 0.001) and VA ( r = −0.388, p < 0.001), whereas the mean RNFL thickness had no significant correlation with MD ( p = 0.082) or VA ( p = 0.226). The mean RNFL thickness had significant difference between moderate-to-severe group and DON group ( p = 0.036). The mean GCL/IPL thickness was thinnest in DON group ( p < 0.001). The MD and BCVA were significantly worse in DON group compared with mild group and moderate-to-severe group ( p < 0.001). The proptosis and IOP were significantly higher in DON group and moderate-to-severe group than mild group ( p < 0.05). The CAS had significant difference between the three groups ( p < 0.001). Clinical activity score (CAS), best corrected visual acuity (BCVA), intraocular pressure (IOP), proptosis and mean deviation (MD) by Humphrey perimetry were assessed. The thickness of RNFL and GCL/IPL were measured by optic coherence tomography (OCT). The eyes with TED were divided into mild group (35 eyes), moderate-to-severe group (42 eyes) and DON group (68 eyes). One hundred and forty-five eyes of 75 patients with TED and 70 eyes of 35 healthy controls were included. To evaluate the changes of retinal nerve fibre layer (RNFL) and ganglion cell layer/inner plexiform layer (GCL/IPL) with the severity of thyroid eye disease (TED).
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