Orbital decompression following treatment with teprotumumab for thyroid eye disease

Nicole J Topilow; Rafaella Cleto Penteado; Michelle Ting; Eman Al-Sharif; George A Villatoro; Jin Sook Yoon; Catherine Y Liu; Bobby S Korn; Don O Kikkawa

doi:10.1016/j.jcjo.2024.06.003

Orbital decompression following treatment with teprotumumab for thyroid eye disease

Can J Ophthalmol. 2024 Jul 24:S0008-4182(24)00174-1. doi: 10.1016/j.jcjo.2024.06.003. Online ahead of print.

Authors

Nicole J Topilow¹, Rafaella Cleto Penteado², Michelle Ting², Eman Al-Sharif², George A Villatoro², Jin Sook Yoon³, Catherine Y Liu², Bobby S Korn⁴, Don O Kikkawa⁴

Affiliations

¹ Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA. Electronic address: ntopilow@gmail.com.
² Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA.
³ Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Yonsei, Korea.
⁴ Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA; Division of Plastic Surgery, Department of Surgery, University of California San Diego Department of Surgery, La Jolla, CA.

PMID: 39059786
DOI: 10.1016/j.jcjo.2024.06.003

Abstract

Objective: To quantify the observed decrease in orbital decompressions being performed at one tertiary care institution and to determine the rate and predictive factors of orbital decompression surgery following treatment with teprotumumab for thyroid eye disease.

Methods: Epic's SlicerDicer program was used to analyze recent trends in the overall number of thyroid eye disease (TED) patients evaluated in the oculoplastic surgery department, as well as usage trends of CPT codes 67445 (lateral orbitotomy with bone removal for decompression) and 67414 (orbitotomy with removal of bone for decompression). A retrospective chart review of active moderate-to-severe TED patients treated with teprotumumab was performed at a single tertiary care center. The main outcome measure was whether or not patients underwent bony orbital decompression surgery following treatment with teprotumumab. The SlicerDicer search demonstrated stable usage of CPT codes 67445 and 67414 from 2016 to 2019, followed by a significant decrease from 2020 to 2023, over a background of increasing numbers of TED patients evaluated in clinic. Following teprotumumab therapy, 25% of patients and 18% of orbits underwent bony decompression. Surgically decompressed patients had higher pre- and post-teprotumumab exophthalmometry measurements compared with patients who did not undergo bony decompression. Average time to decompression following conclusion or cessation of teprotumumab therapy was 12.6 months.

Conclusion: While the number of TED patients treated at one tertiary care center has risen over recent years, the number of orbital decompression surgeries has declined. Orbital decompression, however, is still needed in select patients after treatment with teprotumumab.