TITLE:
Bilateral Retinal Nerve Fiber Layer Loss and Recovery with Teprotumumab in Thyroid Eye Disease
AUTHORS:
Christine Wang, Abdulaziz Alsumait, Nikisha Q. Richards, Surbhi Bansal
KEYWORDS:
Teprotumumab, Thyroid Eye Disease, RNFL, Clinical Activity Score, Ocular Hypertension
JOURNAL NAME:
Open Journal of Ophthalmology,
Vol.14 No.3,
June
12,
2024
ABSTRACT: Background: Thyroid Eye Disease (TED) is known to alter tissues of the orbital cavity, including the optic nerve. However, its effect on measured global Retinal Nerve Fiber Layer (gRNFL) is not well elucidated. This case evaluates the effect of teprotumumab on gRNFL in a patient with moderate TED. Observations: A 60-year-old female with controlled ocular hypertension and moderate TED received 8 standard IV teprotumumab infusions. Comprehensive ocular evaluations were performed pre-, during-, and post-treatment. Bilateral gRNFL thickness decreased (−10 µm OD; −12 µm OS) at 4 months post-treatment start, persisting at 8 months, but recovered at 20 months. Conclusions and Importance: Teprotumumab treatment in patients with TED led to a transient bilateral decrease in gRNFL thickness, which was restored to baseline levels with no adverse events reported. Monitoring gRNFL changes in teprotumumab-treated patients is crucial as gRNFL thinning indicates retinal ganglion cell damage. Teprotumumab’s ability to dampen the IGF-IR inflammatory cascade may have reduced retinal inflammation, leading to recovery.