Patients Treated With Teprotumumab Show Good Outcomes After Strabismus Surgery

This is the first published study to report the outcomes of strabismic diplopia surgery in patients with thyroid eye disease who have undergone a course of teprotumumab therapy.

Study Design

This retrospective case series, involving 7 academic medical centers, reviewed data from 28 patients who underwent surgery between August 2016 and April 2023. Success was defined as relief from diplopia; the definition of success included diplopia corrected by prism glasses or head position in those patients who could not achieve relief from these measures prior to surgery. Patients with intermittent diplopia who derived functional and symptomatic improvement from surgery were also counted as successes.

Outcomes

The mean time from the final round of teprotumumab treatment to strabismus surgery was 7.5 months. Overall, 57% of patients were considered free of diplopia after 1 surgical procedure. Three patients who opted for reoperation (mean deviation of 12 prism diopters [PD] horizontally and 10.3 PD vertically prior to first procedure) had an adjustable suture procedure and achieved a mean postoperative deviation of 0 PD horizontally and 5 PD vertically. Those patients who underwent orbital decompression prior to strabismus surgery were subdivided and analyzed separately (n = 11); in that subpopulation, 45% were diplopia-free after 1 surgery.

Limitations

The descriptive nature of the data and the retrospective limitations of data collection meant that there was a lack of consistent long-term follow-up data and no protocols for determining ocular rotations or forced duction testing. The period between the last teprotumumab treatment and strabismus surgery was short, making predicting success in patients with a longer period between treatment and surgery more difficult. Finally, the study population was relatively small.

Clinical Significance

Patients with TED treated with teprotumumab were found to have good strabismus surgical success rates. These results give clinicians information that they can use when counseling their patients who are treated with teprotumumab about strabismus surgery expectations. While the surgeons who operated on the patients in this study subjectively reported that some patients’ extraocular muscles were tighter than those of strabismus surgery patients not treated with teprotumumab, they also reported the opposite finding in some cases.

Financial Disclosures: Dr. Nikisha Richards discloses financial relationships with Genentech and Horizon Therapeutics (Consultant/Advisor).