Klin Monbl Augenheilkd 2016; 233(12): 1385-1407
DOI: 10.1055/s-0042-118040
Augenheilkunde up2date
Georg Thieme Verlag KG Stuttgart · New York

Endokrine Orbitopathie

Gravesʼ Orbitopathy
A. Eckstein
1   Zentrum für Augenheilkunde, Abteilung für Erkrankungen des vorderen Augenabschnittes, Universität Duisburg-Essen
,
J. Esser
1   Zentrum für Augenheilkunde, Abteilung für Erkrankungen des vorderen Augenabschnittes, Universität Duisburg-Essen
,
S. Mattheis
2   Klinik für Hals-, Nasen- und Ohrenheilkunde, Universität Duisburg-Essen
,
U. Berchner-Pfannschmidt
1   Zentrum für Augenheilkunde, Abteilung für Erkrankungen des vorderen Augenabschnittes, Universität Duisburg-Essen
› Author Affiliations
Further Information

Publication History

Publication Date:
21 November 2016 (online)

Die endokrine Orbitopathie ist die häufigste extrathyreoidale Manifestation des Morbus Basedow. Die klinische Ausprägung ist variabel. Bei schwereren Manifestationen ist die Lebensqualität der Patienten meist erheblich gemindert. Im Gegensatz zu großen Fortschritten in der Grundlagenforschung, durch die Ansätze für zielgerichtete Target-Therapien sichtbar werden, ist die Translation in die Klinik langsam.

Die Therapie der Schilddrüsenüberfunktion als auch der entzündlichen Orbitopathie basiert im Wesentlichen auf Altbewährtem wie der thyreostatischen Therapie und einer Dämpfung des Immunsystems durch Steroide und Orbitaspitzenbestrahlung. Zulassungsstudien für Immunsuppressiva sind für die endokrine Orbitopathie nicht verfügbar, sodass für die Anwendung immer ein Off-Label-Antrag gestellt werden muss. Meist steht die aufwendige Antragsstellung der dringenden Behandlungssituation im Weg. Dies ist vor allem insofern problematisch, als sich in den wenigen randomisierten Studien gezeigt hat, dass nur eine frühe Therapie bei der endokrinen Orbitopathie effektiv ist.

Noch immer ist keine Therapie verfügbar, um bleibende Defekte durch Muskelfibrose und Fettvermehrung in der Augenhöhle vollständig zu vermeiden. Aus diesem Grund ist die chirurgische Therapie bleibender Defekte wesentlicher Inhalt der Therapie der Patienten mit moderaten und schweren Manifestationen.

Literaturverzeichnis als PDF

 
  • Literatur

  • 1 Shan SJ, Douglas RS. The pathophysiology of thyroid eye disease. J Neuroophthalmol 2014; 34: 177-185
  • 2 Bahn RS. Current insights into the pathogenesis of Graves ophthalmopathy. Horm Metab Res 2015; 47: 773-778
  • 3 Khoo DH, Ho SC, Seah LL et al. The combination of absent thyroid peroxidase antibodies and high thyroid-stimulating immunoglobulin levels in Graves disease identifies a group at markedly increased risk of ophthalmopathy. Thyroid 1999; 9: 1175-1180
  • 4 Eckstein AK, Plicht M, Lax H et al. Thyrotropin receptor autoantibodies are independent risk factors for Graves ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 2006; 91: 3464-3470
  • 5 Morshed SA, Davies TF. Graves disease mechanisms: the role of stimulating, blocking, and cleavage region TSH receptor antibodies. Horm Metab Res 2015; 47: 727-734
  • 6 Lytton SD, Ponto KA, Kanitz M et al. A novel thyroid stimulating immunoglobulin bioassay is a functional indicator of activity and severity of Graves orbitopathy. J Clin Endocrinol Metab 2010; 95: 2123-2131
  • 7 Latif R, Morshed SA, Zaidi M et al. The thyroid-stimulating hormone receptor: impact of thyroid-stimulating hormone and thyroid-stimulating hormone receptor antibodies on multimerization, cleavage, and signaling. Endocrinol Metab Clin North Am 2009; 38: 319-341
  • 8 Feldon SE, Park DJ, OʼLoughlin CW et al. Autologous T-lymphocytes stimulate proliferation of orbital fibroblasts derived from patients with Graves ophthalmopathy. Invest Ophthalmol Vis Sci 2005; 46: 3913-3921
  • 9 Tsui S, Naik V, Hoa N et al. Evidence for an association between thyroid-stimulating hormone and insulin-like growth factor 1 receptors: a tale of two antigens implicated in Graves disease. J Immunol 2008; 181: 4397-4405
  • 10 Krieger CC, Neumann S, Place RF et al. Bidirectional TSH and IGF-1 receptor cross talk mediates stimulation of hyaluronan secretion by Graves disease immunoglobins. J Clin Endocrinol Metab 2015; 100: 1071-1077
  • 11 Kuriyan AE, Woeller CF, OʼLoughlin CW et al. Orbital fibroblasts from thyroid eye disease patients differ in proliferative and adipogenic responses depending on disease subtype. Invest Ophthalmol Vis Sci 2013; 54: 7370-7377
  • 12 Draman MS, Grennan-Jones F, Zhang L et al. Effects of prostaglandin f on adipocyte biology relevant to Graves orbitopathy. Thyroid 2013; 12: 1600-1608
  • 13 Anderson DJ, Axel R. Molecular probes for the development and plasticity of neural crest derivatives. Cell 1985; 42: 649-662
  • 14 Brandau S et al. Orbital fibroblasts from Gravesʼorbitopathy patients share functional and immunophenotypic properties with mesenchymal stem/stromal cells. Invest Ophthalmol Vis Sci 2015; 56: 6549-6557
  • 15 Zhang L, Baker G, Janus D et al. Biological effects of thyrotropin receptor activation on human orbital preadipocytes. Invest Ophthalmol Vis Sci 2006; 47: 5197-5203
  • 16 Kumar S, Nadeem S, Stan MN et al. A stimulatory TSH receptor antibody enhances adipogenesis via phosphoinositide 3-kinase activation in orbital preadipocytes from patients with Graves ophthalmopathy. J Mol Endocrinol 2011; 46: 155-163
  • 17 Görtz GE, Horstmann M, Aniol B et al. Hypoxia-dependent HIF-1 activation impacts on tissue remodeling in Graves ophthalmopathy – implications for smoking. JCEM 2016; DOI: 10.1210/jc.2016-1279. [im Druck]
  • 18 Zhang L, Grennan-Jones F. Adipose tissue depot-specific differences in the regulation of hyaluronan production of relevance to Gravesʼ orbitopathy. J Clin Endocrinol Metab 2012; 97: 653-662
  • 19 Moshkelgosha S, So PW, Deasy N et al. Cutting edge: retrobulbar inflammation, adipogenesis, and acute orbital congestion in a preclinical female mouse model of Graves orbitopathy induced by thyrotropin receptor plasmid – in vivo electroporation. Endocrinology 2013; 154: 3008-3015
  • 20 Berchner-Pfannschmidt U et al. Comparative assessment of female mouse model of Gravesʼ orbitopathy under different environments, accompanied by proinflammatory cytokine and T-cell responses to thyrotropin hormone receptor antigen. Endocrinology 2016; 157: 1673-1682
  • 21 Neumann S, Place RF, Krieger CC et al. Future prospects for the treatment of Graves hyperthyroidism and eye disease. Horm Metab Res 2015; 47: 789-796
  • 22 Furmaniak J, Sanders J, Nunez Miguel R et al. Mechanisms of action of TSHR autoantibodies. Horm Metab Res 2015; 47: 735-752
  • 23 Furmaniak J, Sanders J, Rees Smith B. Blocking type TSH receptor antibodies. Auto Immun Highlights 2013; 4: 11-26
  • 24 Bartley GB, Fatourechi V, Kadrmas EF et al. Chronology of Graves ophthalmopathy in an incidence cohort. Am J Ophthalmol 1996; 121: 426-434
  • 25 Wiersinga WM. Quality of life in Graves ophthalmopathy. Best Pract Res Clin Endocrinol Metab 2012; 26: 359-370
  • 26 McKeag D, Lane C, Lazarus JH et al. Clinical features of dysthyroid optic neuropathy: a European Group on Graves Orbitopathy (EUGOGO) survey. Br J Ophthalmol 2007; 91: 455-458
  • 27 Regensburg NI, Wiersinga WM, Berendschot TT et al. Do subtypes of Graves orbitopathy exist?. Ophthalmology 2011; 118: 191-196
  • 28 Perros P, Crombie AL, Kendall-Taylor P. Natural history of thyroid associated ophthalmopathy. Clin Endocrinol (Oxford) 1995; 42: 45-50
  • 29 Mourits MP, Koornneef L, Wiersinga WM et al. Clinical criteria for the assessment of disease activity in Graves ophthalmopathy: a novel approach. Br J Ophthalmol 1989; 73: 639-644
  • 30 Wiersinga WM, Prummel MF, Mourits MP et al. Classification of the eye changes of Graves disease. Thyroid 1991; 1: 357-360
  • 31 Bartalena L, Baldeschi L, Boboridis K et al. The 2016 European Thyroid Association/European Group on Graves Orbitopathy guidelines for the management of Graves orbitopathy. Eur Thyroid J 2016; 5: 9-26
  • 32 Bartalena L, Baldeschi L, Dickinson A et al. Consensus statement of the European Group on Graves Orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 2008; 158: 273-285
  • 33 Dolman PJ, Rootman J. VISA Classification for Graves orbitopathy. Ophthal Plast Reconstr Surg 2006; 22: 319-324
  • 34 Bartalena L et al. More on smoking habits and Gravesʼ ophthalmopathy. J Endocrinol Invest 1989; 12: 733-737
  • 35 Prummel MF, Wiersinga WM. Smoking and risk of Gravesʼ disease. Jama 1993; 269: 479-482
  • 36 Traisk F et al. Thyroid-associated ophthalmopathy after treatment for Gravesʼ hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab 2009; 94: 3700-3707
  • 37 Bartalena L et al. Relation between therapy for hyperthyroidism and the course of Gravesʼ ophthalmopathy. N Engl J Med 1998; 338: 73-78
  • 38 Bartalena L et al. Cigarette smoking and treatment outcomes in Graves ophthalmopathy. Ann Intern Med 1998; 129: 632-635
  • 39 Eckstein A et al. Impact of smoking on the response to treatment of thyroid associated ophthalmopathy. Br J Ophthalmol 2003; 87: 773-776
  • 40 Pfeilschifter J, Ziegler R. Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption. Clin Endocrinol (Oxf), 1996; 45: 477-481
  • 41 Bartalena L et al. The 2016 European Thyroid Association/European Group on Gravesʼ Orbitopathy Guidelines for the Management of Gravesʼ Orbitopathy. Eur Thyroid J 2016; 5: 9-26
  • 42 Tallstedt L, Lundell G, Torring O et al. Occurrence of ophthalmopathy after treatment for Graves hyperthyroidism. The Thyroid Study Group. N Engl J Med 1992; 326: 1733-1738
  • 43 Meyer Zu Horste M, Pateronis K, Walz MK et al. The effect of early thyroidectomy on the course of active Graves orbitopathy (GO): a retrospective case study. Horm Metab Res 2016; 48: 433-439
  • 44 Traisk F, Tallstedt L, Abraham-Nordling M et al. Thyroid-associated ophthalmopathy after treatment for Graves hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab 2009; 94: 3700-3707
  • 45 Bartalena L, Marcocci C, Bogazzi F et al. Relation between therapy for hyperthyroidism and the course of Graves ophthalmopathy. N Engl J Med 1998; 338: 73-78
  • 46 Vannucchi G, Campi I, Covelli D et al. Graves orbitopathy activation after radioactive iodine therapy with and without steroid prophylaxis. J Clin Endocrinol Metab 2009; 94: 3381-3386
  • 47 Lai A, Sassi L, Compri E et al. Lower dose prednisone prevents radioiodine-associated exacerbation of initially mild or absent Graves orbitopathy: a retrospective cohort study. J Clin Endocrinol Metab 2010; 95: 1333-1337
  • 48 Perros P, Kendall-Taylor P, Neoh C et al. A prospective study of the effects of radioiodine therapy for hyperthyroidism in patients with minimally active Graves ophthalmopathy. J Clin Endocrinol Metab 2005; 90: 5321-5323
  • 49 Menconi F, Marino M, Pinchera A et al. Effects of total thyroid ablation vs near-total thyroidectomy alone on mild to moderate Graves orbitopathy treated with intravenous glucocorticoids. J Clin Endocrinol Metab 2007; 92: 1653-1658
  • 50 Menconi F, Leo M, Vitti P et al. Total thyroid ablation in Graves orbitopathy. J Endocrinol Invest 2015; 38: 809-815
  • 51 Marcocci C, Kahaly GJ, Krassas GE et al. Selenium and the course of mild Graves orbitopathy. N Engl J Med 2011; 364: 1920-1931
  • 52 Zang S, Ponto KA, Kahaly GJ. Clinical review: Intravenous glucocorticoids for Graves orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab 2011; 96: 320-332
  • 53 Kahaly GJ, Pitz S, Hommel G et al. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves orbitopathy. J Clin Endocrinol Metab 2005; 90: 5234-5240
  • 54 Bartalena L, Krassas GE, Wiersinga W et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves orbitopathy. J Clin Endocrinol Metab 2012; 97: 4454-4463
  • 55 Le Moli R, Baldeschi L, Saeed P et al. Determinants of liver damage associated with intravenous methylprednisolone pulse therapy in Graves ophthalmopathy. Thyroid 2007; 17: 357-362
  • 56 Mourits MP, van Kempen-Harteveld ML, Garcia MB et al. Radiotherapy for Graves orbitopathy: randomised placebo-controlled study. Lancet 2000; 355: 1505-1509
  • 57 Prummel MF, Terwee CB, Gerding MN et al. A randomized controlled trial of orbital radiotherapy versus sham irradiation in patients with mild Graves ophthalmopathy. J Clin Endocrinol Metab 2004; 89: 15-20
  • 58 Johnson KT, Wittig A, Loesch C et al. A retrospective study on the efficacy of total absorbed orbital doses of 12, 16 and 20 Gy combined with systemic steroid treatment in patients with Graves orbitopathy. Graefes Arch Clin Exp Ophthalmol 2010; 248: 103-109
  • 59 Marcocci C, Bartalena L, Bogazzi F et al. Orbital radiotherapy combined with high dose systemic glucocorticoids for Graves ophthalmopathy is more effective than radiotherapy alone: results of a prospective randomized study. J Endocrinol Invest 1991; 14: 853-860
  • 60 Gorman CA, Garrity JA, Fatourechi V et al. A prospective, randomized, double-blind, placebo-controlled study of orbital radiotherapy for Graves ophthalmopathy. Ophthalmology 2001; 108: 1523-1534
  • 61 Gerling J, Kommerell G, Henne K et al. Retrobulbar irradiation for thyroid-associated orbitopathy: double-blind comparison between 2.4 and 16 Gy. Int J Radiat Oncol Biol Phys 2003; 55: 182-189
  • 62 Kahaly G, Schrezenmeir J, Krause U et al. Ciclosporin and prednisone v. prednisone in treatment of Graves ophthalmopathy: a controlled, randomized and prospective study. Eur J Clin Invest 1986; 16: 415-422
  • 63 Ghadiri N. The management of thyroid eye disease by immunomodulation – The Cambridge regime. International Thyroid Eye Disease Society Symposium 2016. London: 2016
  • 64 Salvi M, Vannucchi G, Curro N et al. Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves orbitopathy: a randomized controlled study. J Clin Endocrinol Metab 2015; 100: 422-431
  • 65 Stan MN, Garrity JA, Carranza Leon BG et al. Randomized controlled trial of rituximab in patients with Graves orbitopathy. J Clin Endocrinol Metab 2015; 100: 432-441
  • 66 Ueki I, Abiru N, Kobayashi M et al. B cell-targeted therapy with anti-CD20 monoclonal antibody in a mouse model of Graves hyperthyroidism. Clin Exp Immunol 2011; 163: 309-317
  • 67 Mitchell AL, Gan EH, Morris M et al. The effect of B cell depletion therapy on anti-TSH receptor antibodies and clinical outcome in glucocorticoid-refractory Graves orbitopathy. Clin Endocrinol (Oxford) 2013; 79: 437-442
  • 68 Heyes C, Nolan R, Leahy M et al. Treatment-resistant elephantiasic thyroid dermopathy responding to rituximab and plasmapheresis. Australas J Dermatol 2012; 53: e1-e4
  • 69 Riedl M, Kuhn A, Kramer I et al. Prospective, systematically recorded mycophenolate safety data in Graves orbitopathy. J Endocrinol Invest 2016; 39: 687-694
  • 70 Wakelkamp I, Baldeschi L, Saeed P et al. Surgical or medical decompression as a first-line treatment of optic neuropathy in Graves ophthalmopathy? A randomized controlled trial. Clin Endocrinol (Oxford) 2005; 63: 323-328
  • 71 Curro N, Covelli D, Vannucchi G et al. Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Thyroid 2014; 24: 897-905
  • 72 Messmer EM. The pathophysiology, diagnosis, and treatment of dry eye disease. Dtsch Ärztebl Int 2015; 112: 71-81 quiz 82
  • 73 Wabbels B, Forl M. [Botulinum toxin treatment for crocodile tears, spastic entropion and for dysthyroid upper eyelid retraction]. Ophthalmologe 2007; 104: 771-776
  • 74 Salour H, Bagheri B, Aletaha M et al. Transcutaneous dysport injection for treatment of upper eyelid retraction associated with thyroid eye disease. Orbit 2010; 29: 114-118
  • 75 Shih MJ, Liao SL, Lu HY. A single transcutaneous injection with Botox for dysthyroid lid retraction. Eye 2004; 18: 466-469
  • 76 Uddin JM, Davies PD. Treatment of upper eyelid retraction associated with thyroid eye disease with subconjunctival botulinum toxin injection. Ophthalmology 2002; 109: 1183-1187
  • 77 Ebner R. Botulinum toxin type A in upper lid retraction of Graves ophthalmopathy. J Clin Neuroophthalmol 1993; 13: 258-261
  • 78 Chee E, Chee SP. Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series. Eye (London) 2008; 22: 311-315
  • 79 Lee SJ, Rim TH, Jang SY et al. Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections. Graefes Arch Clin Exp Ophthalmol 2013; 251: 261-270
  • 80 Eckstein A, Esser J. Surgical Management of extraocular Muscle Dysfunction in Patients with GO. In: Bahn RS, ed. Graves’ Disease. New York: Springer; 2015
  • 81 Abramoff MD, Kalmann R, de Graaf ME et al. Rectus extraocular muscle paths and decompression surgery for Graves orbitopathy: mechanism of motility disturbances. Invest Ophthalmol Vis Sci 2002; 43: 300-307
  • 82 Rocchi R, Lenzi R, Marino M et al. Rehabilitative orbital decompression for Graves orbitopathy: risk factors influencing the new onset of diplopia in primary gaze, outcome, and patients satisfaction. Thyroid 2012; 22: 1170-1175
  • 83 Ben Simon GJ, Syed HM, Lee S et al. Strabismus after deep lateral wall orbital decompression in thyroid-related orbitopathy patients using automated hess screen. Ophthalmology 2006; 113: 1050-1055
  • 84 Baldeschi L, MacAndie K, Hintschich C et al. The removal of the deep lateral wall in orbital decompression: its contribution to exophthalmos reduction and influence on consecutive diplopia. Am J Ophthalmol 2005; 140: 642-647
  • 85 Fayers T, Barker LE, Verity DH et al. Oscillopsia after lateral wall orbital decompression. Ophthalmology 2013; 120: 1920-1923
  • 86 Rocchi R, Lenzi R, Marino M et al. Rehabilitative orbital decompression for Graves orbitopathy: risk factors influencing the new onset of diplopia in primary gaze, outcome and patients satisfaction. A large retrospective study. Thyroid 2012; 22: 1170-1175
  • 87 Sellari-Franceschini S, Berrettini S, Santoro A et al. Orbital decompression in Graves ophthalmopathy by medial and lateral wall removal. Otolaryngol Head Neck Surg 2005; 133: 185-189
  • 88 Kim JW, Goldberg RA, Shorr N. The inferomedial orbital strut: an anatomic and radiographic study. Ophthal Plast Reconstr Surg 2002; 18: 355-364
  • 89 Kaminsky J, Ridder GJ, Eckstein A et al. Operative Therapie bei endokriner Orbitopathie. Ophthalmologe 2011; 108: 432-439
  • 90 Kushner BJ. Torsional diplopia after transantral orbital decompression and extraocular muscle surgery associated with Graves orbitopathy. Am J Ophthalmol 1992; 114: 239-240
  • 91 McCann JD, Goldberg RA, Anderson RL et al. Medial wall decompression for optic neuropathy but lateral wall decompression with fat removal for non vision-threatening indications. Am J Ophthalmol 2006; 141: 916-917
  • 92 Yao WC, Sedaghat AR, Yadav P et al. Orbital decompression in the endoscopic age: The modified inferomedial orbital strut. Otolaryngol Head Neck Surg 2016; 154: 963-969
  • 93 Reich SS, Null RC, Timoney PJ et al. Trends in orbital decompression techniques of surveyed ASOPRS Members. Ophthal Plast Reconstr Surg 2015; DOI: 10.1097/IOP.0000000000000573.
  • 94 Mourits MP, Bijl H, Altea MA et al. Outcome of orbital decompression for disfiguring proptosis in patients with Graves orbitopathy using various surgical procedures. Br J Ophthalmol 2009; 93: 1518-1523
  • 95 Olivari N. Transpalpebral decompression of endocrine ophthalmopathy (Graves disease) by removal of intraorbital fat: experience with 147 operations over 5 years. Plast Reconstr Surg 1991; 87: 627-641 discussion 642–643
  • 96 Jordan DR. Re: “Orbital Fat Decompression for Thyroid Eye Disease: Retrospective Case Review and Criteria for Optimal Case Selection”. Ophthal Plast Reconstr Surg 2016; 32: 72
  • 97 Kahaly GJ, Petrak F, Hardt J et al. Psychosocial morbidity of Graves orbitopathy. Clin Endocrinol (Oxford) 2005; 63: 395-402
  • 98 Eckstein A, Schulz S, Esser J. [Is combined surgical correction of horizontal and vertical squint of value in Graves ophthalmopathy?]. Klin Monatsbl Augenheilkd 2004; 221: 769-775
  • 99 Jellema HM, Saeed P, Everhard-Halm Y et al. Bilateral inferior rectus muscle recession in patients with Graves orbitopathy: is it effective?. Ophthal Plast Reconstr Surg 2012; 28: 268-272
  • 100 Schittkowski M, Fichter N, Guthoff R. [Strabismus surgery in Graveʼs disease – dose-effect relationships and functional results]. Augenmuskeloperationen bei endokriner Orbitopathie: Dosis-Wirkungs-Beziehung und funktionelle Ergebnisse. Klin Monatsbl Augenheilkd 2004; 221: 941-947
  • 101 Eckstein A, Raczynski S, Dekowski D et al. [Contralateral recession of the inferior oblique muscle in Graves disease patients with mild M. rectus inferior fibrosis ] Klin Monatsbl Augenheilkd 2015; 232: 1178-1183
  • 102 Mocan MC, Ament C, Azar NF. The characteristics and surgical outcomes of medial rectus recessions in Graves ophthalmopathy. J Pediatr Ophthalmol Strabismus 2007; 44: 93-100
  • 103 Schlüter S, Dekowski D, Stechmann D et al. Primäre und sekundäre Rücklagerung des M. rectus superior bei Endokriner Orbitopathie. Z Prakt Augenheilkd 2015; 36: 37-41
  • 104 Esser J. Ergebnisse der Einmuskelchirurgie bei Endokriner Orbitopathie. Z Prakt Augenheilkd 1993; 14: 280-292
  • 105 Eckstein A, Weiermüller C, Holdt M et al. Schielformen und Augenmuskeloperationen nach Orbitadekompression. Z Prakt Augenheilkd 2011; 32: 335-344
  • 106 Eckstein A et al. Schielformen und Augenmuskeloperationen nach Orbitadekompression. Z prakt Augenheilk 2011; 32: 335-344
  • 107 Schittkowski M, Fichter N, Guthoff R. [Strabismus surgery in Graveʼs disease—dose-effect relationships and functional results]. Klin Monatsbl Augenheilkd 2004; 221: 941-947
  • 108 Schlüter S et al. Primäre und sekundäre Rücklagerung des M. rectus superior bei Endokriner Orbitopathie. Z prakt Augenheilk 2015; 36
  • 109 Eckstein A et al. Contralateral recession of the inferior oblique muscle in Gravesʼ disease patients with mild M. rectus inferior fibrosis. Klin Monbl Augenheilkd 2015; 232: 1178-1183
  • 110 Esser J. Ergebnisse der Einmuskelchirurgie bei Endokriner Orbitopathie. Z prakt Augenheilk 1993; 14: 280-292
  • 111 Esser J, Eckstein A. Ocular muscle and eyelid surgery in thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes 1999; 107 (Suppl. 05) S214-S221
  • 112 Esser J, Schittkowski M, Eckstein A. [Gravesʼ orbitopaty: inferior rectus tendon elongation for large vertical squint angles that cannot be corrected by simple muscle recession]. Klin Monbl Augenheilkd 2011; 228: 880-886
  • 113 Esser J, Eckstein A. Ocular muscle and eyelid surgery in thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes 1999; 107 (Suppl. 05) S214-S221
  • 114 Esser J, Schittkowski M, Eckstein A. Endokrine Orbitopathie: M.-rectus-inferior-Sehnenverlängerung bei großen vertikalen Schielwinkeln, die nicht durch eine einfache Muskelrücklagerung korrigiert werden können. Klin Monatsbl Augenheilkd 2011; 228: 880-886
  • 115 Eckstein A, Schittkowski M, Esser J. Surgical treatment of Graves ophthalmopathy. Best Pract Res Clin Endocrinol Metab 2012; 26: 339-358
  • 116 Eckstein A, Esser J. Durch eine kleine temporale Tarsorrhaphie lässt sich der Effekt der Unterlidverlängerung mit Implantat bei Patienten einer Endokrinen Orbitopathie signifikant steigern. Klin Monatsbl Augenheilkd 2011; 228: 887-891
  • 117 Baldeschi L. Correction of lid retraction and exophthalmos. Dev Ophthalmol 2008; 41: 103-126
  • 118 Hintschich C, Haritoglou C. Full thickness eyelid transsection (blepharotomy) for upper eyelid lengthening in lid retraction associated with Graves disease. Br J Ophthalmol 2005; 89: 413-416
  • 119 Mourits MP, Sasim IV. A single technique to correct various degrees of upper lid retraction in patients with Graves orbitopathy. Br J Ophthalmol 1999; 83: 81-84
  • 120 Olver JM, Rose GE, Khaw PT et al. Correction of lower eyelid retraction in thyroid eye disease: a randomised controlled trial of retractor tenotomy with adjuvant antimetabolite versus scleral graft. Br J Ophthalmol 1998; 82: 174-180
  • 121 Mourits MP, Koornneef L. Lid lengthening by sclera interposition for eyelid retraction in Graves ophthalmopathy. Br J Ophthalmol 1991; 75: 344-347
  • 122 Harvey JT, Corin S, Nixon D et al. Modified levator aponeurosis recession for upper eyelid retraction in Graves disease. Ophthalmic Surg 1991; 22: 313-317
  • 123 Schittkowski MP, Fichter N, Guthoff RF. Das freie autologe Tarsustransplantat als Spacer zur Behandlung der Unterlidretraktion bei Endokriner Orbitopathie. Klin Monatsbl Augenheilkd 2008; 225: 708-712
  • 124 Feldman KA, Putterman AM, Farber MD. Surgical treatment of thyroid-related lower eyelid retraction: a modified approach. Ophthal Plast Reconstr Surg 1992; 8: 278-286
  • 125 Neoh C, Eckstein A. Eyelid Surgery. In: Wiersinga WM, Kahaly GJ, eds. Graves’ Orbitopathy: A multidiscplinary Approach Questions and Answers. Basel: Karger; 2010: 200-210
  • 126 Bartalena L, Baldeschi L, Boboridis K et al. The 2016 European Thyroid Association/European Group on Gravesʼ Orbitopathy Guidelines for the Management of Gravesʼ Orbitopathy. Eur Thyroid J 2016; 5: 9-26