Yeni Tanı Graves Hastalarında Oftalmopati: İlk Tanıda Klinik-Ortoptik Özellikler ve Klinik Bulguların Manyetik Rezonans Görüntüleme Bulguları Ile Korelasyonu
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Ophthalmopathy at Newly Diagnosed Graves Patients: Clinical-Orthoptical Features at First Diagnosis and Correlations of Clinical Findings with Magnetic Resonance Image Findings, Hacettepe University Medical Faculty, Ophthalmology Department, Expertise Thesis, Ankara, 2014. The purpose of current study is to evaluate ophthalmopathy presence and severity at first examination, to evaluate orthoptic exam findings and to interpret the correlation between clinical findings and Magnetic Resonance Imaging (MRI). For this purpose ophthalmologic and orthoptic examination findings, Hertel exophthalmometer findings, binocular visual field maps, orbital MRI findings regarding in respect of extraocular muscle involvement and presence of exophthalmos were evaluated in 36 newly diagnosed Graves patients and 23 healthy individuals whose ophthalmologic findings were normal. The mean age was 40±13 years in disease group (19-75) and 37±15 years (18-70) in control (p= 0.10). According to European Group On Graves' Orbitopathy (EUGOGO) staging, in the Graves group, mild orbitopathy was found in 34 patients and severe orbitopathy in 2 patients. 11 patients in Graves group had diplopia in binocular visual field whereas only 2 patients with severe staging was clinically found to have diplopia. Exophthalmos measuring on MRI was found higher in Graves group than in control group, the results were statistically meaningful for the left eye (p<0.01). Exophthalmos measurements determined by MRI was meaningfully higher than measurements taken with Hertel exophthalmometer at Graves group (p<0.01). Comparing MRI findings of extraocular muscles, it was found that the long diameter of superior oblique muscle of the left eye was meaningfully thicker at Graves group (p<0.01). In addition, it was found that signal density of superior oblique muscle on MRI was higher than the control group (p=0.012). According to EUGOGO, the presence of torsion was shown only in 2 patients, who had severe staged disease. As a result, in all newly diagnosed Graves patients, ophthalmopathy was seen at different stages according to EUGOGO clinical staging. There were no meaningful changes in MRI of extraocular muscles of mild staged Graves patients. MRI evaluation seems to be mandatory in terms of ophthalmopathy diagnosis in newly diagnosed Graves patients, if there is no clinical finding.