The aim of this paper is to describe and analyse the retinal involvement and Optical Coherence Tomography (OCT) findings in Progressive Outer Retinal Necrosis (PORN) and revisiting its terminology. Retrospective review of 26 eyes of 15 HIV-positive patients diagnosed with PORN. Cases were confirmed based on history, clinical features, and OCT imaging. Patients with media opacities were excluded. Clinical records, retinal fundus photography images and serial OCT images were reviewed from initial presentation to final follow-up. Retinal changes, extent and layers of retinal involvement and other OCT features of eyes diagnosed as PORN were analysed. OCT findings revealed that 61.5% of eyes exhibited increased inner retinal thickness, while 69.2% demonstrated hyperreflectivity of the inner retinal layers at initial presentation, both of which resolved over time. The outer retinal layers remained structurally intact initially but showed full-thickness necrosis in advanced cases. OCT findings indicate that inner retinal involvement preceded outer retinal necrosis. As the retinal necrosis originates in the inner retina and progresses towards the outer retina, OCT and histopathological evidence suggest that "Progressive Outer Retinal Necrosis" is a misnomer. The term "Acute Aggressive Posterior Progressive Necrotising Retinitis" is a more accurate term that characterizes the disease pathophysiology.
Epiretinal membrane (ERM) is a prevalent vitreoretinal interface disorder characterized by fibro-cellular proliferation on the inner retinal surface. The prevalence increases markedly with age, and progressive membrane contraction distorts retinal architecture, producing metamorphopsia and irreversible visual impairment thereby significantly impairing patients' quality of life. This highlights the need for more accurate and efficient diagnostic and therapeutic strategies. Artificial intelligence (AI) has emerged as a promising tool to address such challenges. This review summarizes and evaluates recent studies on the applications of AI in ERM management, identifying current limitations and future research directions. A comprehensive literature search was conducted in PubMed, Web of Science, Embase, and Cochrane Library databases, focusing on studies related to AI and ERM published over the past decade. The findings indicate that while research on treatment and prognosis prediction remains limited, and new technologies are expected in image processing, current AI models demonstrate substantial potential in the ERM management, especially in detection and diagnosis. Nonetheless, current evidence is constrained by challenges such as single-center design, limited external validation across devices or ethnicities, insufficient multimodal imaging, and lack of health-economic or workflow integration data. Future multicenter prospective studies, federated learning platforms, publicly annotated imaging dataset and cost-effectiveness analyses are warranted to develop robust, generalizable models that can be seamlessly integrated into clinical workflows, substantially optimizing ERM management and delivering tangible benefits to both patients and clinical practice.
Intraocular tuberculosis (OTb) is a sight-threatening manifestation of Mycobaterium tuberculosis infection. It is characterized by a wide spectrum of clinical phenotypes, including anterior uveitis, posterior uveitis, retinal vasculitis, and choroiditis. Diagnosis remains challenging due to its diverse clinical presentations and the absence of standardized criteria. This review summarizes current knowledge on the clinical spectrum, diagnostic modalities, and emerging management strategies for OTb. A comprehensive systemic literature search was conducted on Medline and PubMed to identify relevant studies on ocular tuberculosis. Key diagnostic tools include optical coherence tomography (OCT), fluorescein angiography (FA), interferon-gamma release assays (IGRA), polymerase chain reaction (PCR), and high-resolution computerized tomography (HRCT). Management typically involves a combination of anti-tuberculosis therapy (ATT) and corticosteroids, although optimal treatment regimens remain a topic of ongoing debate. Emerging challenges in treatment include paradoxical worsening, drug resistance, and corticosteroid dependency. Recent advancements, such as intravitreal anti-VEGF agents, moxifloxacin, and immunomodulatory therapy, have shown promise in refractory cases. A multidisciplinary approach is essential for the timely diagnosis, individualized treatment, and improved visual outcomes in patients with  intraocular tuberculosis.
The benefits of anti-tubercular therapy (ATT) in treating ocular tuberculosis (TB) are well documented. However, the optimal duration of ATT remains uncertain. We assessed the efficacy of 6-month ATT compared to 9-month therapy in preventing recurrent intraocular inflammation. Multi-center, open-label, non-inferiority, randomized controlled trial across three centers in India, Myanmar, and Thailand. Patients aged ≥ 18 years with tubercular posterior uveitis (retinal vasculitis, serpiginous-like choroiditis [SLC] or multifocal choroiditis) were randomized to receive either 6- or 9-month ATT. Systemic corticosteroids were mandatory for SLC and, at the treating physician's discretion, for other phenotypes. The primary outcome measure was the non-recurrence of inflammation 1 year after ATT. Sixty-four patients (64.1% males, median age 38 years [22-70], 43.8% bilateral) were randomized across the three sites during the study period. Thirty patients were assigned to the 6-month arm and 34 to the 9-month arm. Both treatments demonstrated a high non-recurrence rate on intention-to-treat (ITT) analysis (0.94 [0.79-0.99] for 9-month [n = 32] and 0.85 [0.65-0.96] for 6-month treatment [n = 26]). The difference in proportion remained below the non-inferiority margin (0.16) for both the ITT (0.09 [84% CI -0.02 - 0.2]) and per-protocol (0.13 [84% CI 0.01 - 0.25]) analyses. In subgroup analysis, retinal vasculitis appeared to favor 6-month ATT, and SLC 9-months, with the confidence intervals not deviating on bootstrap resampling. No discontinuation due to drug toxicity was reported in either group. Six-month ATT is non-inferior to 9-month ATT for treating tubercular posterior uveitis, though it may vary between the different clinical phenotypes.
This study aims to analyze the expression of presumably critical inflammatory mediators including cytokines, chemokines, secretory, binding, and matrix proteins, and IgE in Vernal keratoconjunctivitis (VKC)-relevant age groups: children, adolescents, and adults. The tears (n = 16) and serum (n = 12) samples from active, chronic VKC cases, without treatment at the time of sampling, were collected from the tertiary eye care centers of L V Prasad Eye Institute, located in Hyderabad and Bhubaneswar, during 2021-2022. The age-matched healthy individuals were taken as controls. The subjects were grouped as: children (1-11 years), adolescents (12-21 years), and adults (> 21 years). The expression of a specific panel of Th1- (IL-36γ and MMP-9) and Th2-inflammatory mediators (IL-6, Vitamin D-binding protein (VDBP), MUC5AC, FcεR1, MCP-1, IgE, GM-CSF) was analyzed through ELISA. Compared to controls, the expression of IgE was upregulated in tears and serum samples of all VKC patients, whereas IL-6, MMP-9, and MUC5AC were upregulated, and VDBP was downregulated in children's tear samples. The VDBP and MCP-1 recorded the highest and lowest protein expression (pg/ml) among all the inflammatory mediators, respectively. The IL-36γ was upregulated in tears and serum samples of adolescents and adults. Our results suggest differential expressions of chosen Th1- and Th2-mediators in tears and serum samples of children, adolescents, and adults with active VKC. Compared with controls, our findings specifically suggest: i) upregulation of IgE, IL-6, MMP-9, and MUC5AC, and downregulation of VDBP in tear samples of children, and ii) upregulation of IgE and IL-36γ in adolescents and adults.
To evaluate the influence of capsular tension ring (CTR) implantation on the rotational stability of intraocular lenses (IOLs) by separately analyzing IOL rotation and IOL misalignment. PubMed, EMBASE, Web of Science, CENTRAL, and Google Scholar were searched through October 2025. IOL rotation was defined as the absolute axis change from the immediate postoperative position to final follow-up. IOL misalignment was defined as the absolute deviation between the intended surgical axis and the measured postoperative axis. Outcomes included mean rotation or misalignment (degrees) and the proportion of eyes exceeding 5-, 10-, and 15-degree thresholds. Random-effects models were used to calculate pooled mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses were stratified by IOL haptic design and high myopia status. Evidence certainty was assessed using the GRADE framework. Twelve studies (1251 eyes; 639 CTR, 612 non-CTR) were included. CTR implantation did not significantly reduce mean IOL rotation (MD - 0.40 degrees; 95% CI, -1.20 to 0.39; p = .322). No significant differences were observed for the proportion of eyes with rotation exceeding 5 degrees (p = .150), 10 degrees (p = .065), or 15 degrees (p = .176). For IOL misalignment, the overall pooled effect was not significant (MD - 1.46 degrees; 95% CI, -3.08 to 0.17; p = .079). However, subgroup analysis demonstrated a significant interaction by haptic design (p = .005). CTR implantation significantly reduced misalignment for loop-haptic IOLs (MD - 1.25 degrees; 95% CI, 1.73 to -0.77; p < .001) and for plate-haptic IOLs (MD - 3.18 degrees; 95% CI, -6.29 to -0.08; p = .045). The proportion of IOL misalignment exceeding 5 degrees was significantly lower in the CTR group (RR 0.53; 95% CI, 0.31 to 0.89; p = .018). CTR implantation did not significantly reduce mean IOL rotation or the proportion of outlier rotation at final follow-up (moderate-certainty evidence). Exploratory analysis based on very low-certainty observational evidence suggests that CTR may reduce IOL misalignment, particularly for loop-haptic IOLs, but these findings require confirmation in adequately powered RCTs.
To differentiate the clinical features of fungal keratitis with predominantly deep stromal and endothelial (FSKE) involvement and HSV Endothelial Keratitis (HEK). Medical records of patients diagnosed with FSKE or HEK between January 2019 and March 2024 were reviewed. We included cases presenting with predominant posterior stromal infiltrates and endothelial exudates that were later confirmed as fungal etiology by microbiology or confocal imaging. These were compared with confirmed HSV endothelial keratitis, diagnosed clinically and/or by PCR (Polymerase Chain Reaction). A total of 77 cases were included in the study, of which 45 were of FSKE and 32 of HEK. Hyphate edges, along with satellite lesions and the presence of hypopyon, are more commonly seen in fungal cases (66.6% (FSKE) vs. 3.1%, (HEK) OR = 62.0, p = .0001). Posterior stromal involvement was also significantly higher in fungal cases (46.6% vs. 8.8%, OR = 9.4, p = .001). Exudates over the endothelial surface (Endo-exudates) were defined as fluffy in cases with Fungal keratitis as opposed to HSV, where they were more of multiple dot-like (OR = 4.1, p = .005). An intact epithelium was more frequently noted in HEK (84.3% vs. 60% in FSKE, OR = 3.5, p = .02), with the presence of corneal oedema (46.8% vs. 13.3%, OR = 5.7, p = .001). Sampling of these endo-exudates revealed the presence of fungal filaments in 88.8% of fungal keratitis. Hyphate edges, satellite lesions, hypopyon, fluffy endothelial exudates, and posterior stromal involvement strongly suggest fungal aetiology, whereas intact epithelium, corneal edema, and dot-like endothelial exudates favour HSV.
We aimed to evaluate the risk factors of ocular complications associated with orbital fractures in a large cohort of patients. In this retrospective study, we analyzed the medical records of 1416 consecutive orbital fracture patients treated at Kyoto Prefectural University of Medicine, Kyoto, Japan between March 2009 and April 2025. Fracture characteristics, causes of injury, and the frequency of ocular complications were assessed via clinical records and associated computed tomography scan images. The factors associated with ocular complications were evaluated with multivariate logistic regression analysis. Ocular complications occurred in 9.5% of the cases, with traumatic mydriasis, hyphema, and commotio retinae being the most common. Multivariate logistic regression identified sports-related injury (OR,2.19; 95% CI, 1.73-2.77, p < .01), male sex (OR,1.51; 95% CI, 1.12-2.03, p < .01), non-trapdoor fracture (OR,1.34; 95% CI, 1.01-1.80, p < .05), combined medial wall and orbital floor fractures (OR,1.32; 95% CI, 1.05-1.67, p = .02) and zygomatic or maxilla bone fracture (OR,1.34; 95% CI, 1.00-1.79, p < .05) as independent predictors of ocular complications. Sports-related injury, particularly those associated with golf and baseball, showed the highest rate of ocular complications, with golf-related orbital fractures resulting in a 100% complication rate and baseball-related orbital fractures resulting in a 38.1% complication rate. Sports-related injuries, male sex, non-trapdoor fractures, combined medial wall and orbital floor fractures and zygomatic or maxilla bone fracture are risk factors for ocular complications. Golf and baseball related orbital fractures are associated with a particularly high incidence of ocular complications, and urgent ophthalmologic examination is warranted in these cases.
To synthesize contemporary evidence on Boston KPro outcomes in autoimmune cohorts and outline practical strategies to improve anatomic retention and visual results. A review. The Boston keratoprosthesis (KPro) is the most widely implanted artificial cornea and a critical option for visual rehabilitation in patients at high risk of graft failure. Autoimmune disorders, including Stevens-Johnson syndrome (SJS), Sjögren's disease (SjD), ocular mucous membrane pemphigoid (OMMP), and ocular graft-versus-host disease (oGVHD), create highly inflammatory, cicatricial ocular surface environments characterized by severe dry eye, limbal stem cell deficiency, and corneal neovascularization, all of which undermine conventional keratoplasty. While selected patients with a relatively "wet" and medically quiet surface can benefit from Type 1 KPro, most end-stage cicatricial phenotypes are better served by Type 2 KPro or alternative mucous-membrane-covered devices. Across studies, autoimmune etiology is consistently associated with higher rates of tissue melt, infectious/sterile keratitis, retroprosthetic membrane, glaucoma, and vitreoretinal complications compared with non-autoimmune eyes. A structured perioperative bundle, systemic disease quiescence for ≥3 months, rheumatology co-management, prophylactic glaucoma drainage devices when indicated, long-term bandage contact lens wear, and intensified antibiotic ± antifungal prophylaxis appear to mitigate risk. Emerging approaches (biologics, donor-carrier crosslinking, γ-irradiated tissue, and newer KPro designs) show promise but require standardized endpoints and multicenter registries. Despite substantial challenges, the Boston KPro remains a vision-restoring option for carefully selected autoimmune patients when performed within multidisciplinary programs using rigorous preventive protocols.
Non-melanoma skin cancers (NMSCs) of the periocular region present significant clinical challenges, with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) being the most prevalent. The purpose of this study is to report on the outcomes of anti-programmed death (PD-1)/PD-L1 immunotherapy in patients with locally advanced periorbital NMSCs. We conducted a retrospective study of the patients treated for locally advanced periocular BCC and cutaneous SCC using anti-PD-1/PD-L1 immunotherapy from January 2016 to January 2023. Patient records were reviewed for clinical and histological data, and all were evaluated for the effectiveness of the therapy. The study included nine patients with a mean age of 68.2 years. Four patients had periocular BCC, and five had cutaneous SCC. Most patients had received prior treatments, including surgical resection, radiation, and systemic chemotherapy. Six patients were treated with cemiplimab, one with nivolumab, one with pembrolizumab, and one underwent trials of all three medications. Anti-PD-1/PD-L1 therapy proved effective in two patients with BCC and two with SCC. All responsive cases were treated with cemiplimab. Anti-PD-1/PD-L1 immunotherapy appears to be a promising option for treating locally advanced periocular BCC and cutaneous SCC, especially in cases where traditional treatments fail. Future research should involve nationwide databases or multi-institutional collaborations to validate the results and clarify the use of immune checkpoint inhibitors for periorbital NMSCs as adjuvant therapy.
This study aimed to provide a comprehensive bibliometric analysis of retinoblastoma treatment, assessing publication trends, influential research, and leading contributors. The research was conducted using the Web of Science Core Collection, focusing on retinoblastoma treatment from January 1, 1941, to June 13, 2024. Bibliometric analysis were conducted using Microsoft Excel, VOSviewer, CiteSpace, and the Bibliometrics R package. The analysis identified 5,674 documents. The United States led in research output and citation impact, followed by China and Europe. The University of Toronto was the most prolific institution (488 articles). International collaborations accounted for 18.54% of publications. David H. Abramson was the most prolific author (139 articles), followed closely by C.L. Shields (100 articles). Keyword analysis revealed three major thematic clusters: (1) molecular mechanisms and oncogenesis, (2) cell cycle regulation and experimental models, and (3) clinical management and therapeutic strategies. Recent hotspots included intraarterial chemotherapy, melphalan, treatment resistance, risk stratification, and tumor biology. Retinoblastoma research centers on molecular mechanisms, cell cycle regulation, and clinical management. Advances in intraarterial chemotherapy, risk assessment, and molecular insights are improving survival and quality of life. Greater emphasis on real-world, multicenter, and international studies is needed to advance personalized care.
To assess the prognostic role of dual margins on fundus autofluorescence (AF) in predicting treatment outcomes in tubercular serpiginous-like choroiditis (TB SLC). Retrospective interventional study. Patients with active TB SLC demonstrating dual hyperautofluorescent margins with an intervening hypoautofluorescent zone on baseline AF, positive laboratory evidence of tuberculosis, radiological evidence of active or healed TB, and ≥3 months follow-up were included. Each case was matched with three controls without dual margins. All patients received oral corticosteroids (prednisolone 1 mg/kg, tapered over 1-2 months) with concurrent antitubercular therapy. Primary outcomes were paradoxical worsening (PW), recurrence, and need for additional immunosuppression. Logistic regression was used to analyze risk factors for PW. Three hundred and sixty-six patients of active SLC were screened and twenty-one cases and 63 controls were evaluated. PW occurred significantly more often in the dual-margin group (47.6% vs. 14.3%, p = .002). Recurrence rates were comparable (9% vs. 6%, p = .63). Escalation of immunosuppression, including increased corticosteroid use or additional immunomodulatory therapy, was required more frequently in cases (47.6% vs. 20.6%, p = .01). Dual AF margins may serve as an imaging biomarker of aggressive TB SLC and may predict higher risk of PW and greater immunosuppressive requirements. Early recognition may facilitate closer follow-up and timely therapeutic escalation.
To investigate the pedigree-based penetrance analysis in Korean Leber hereditary optic neuropathy (LHON). The pedigrees of 32 LHON patients' families were thoroughly examined. Index patients were probands diagnosed by mitochondrial DNA (mtDNA) mutation at the position of 11,778 or 11,484, while secondary cases were affected relatives ascertained through index cases. We identified susceptible and at-risk family members of the index patients. We categorized susceptible individuals as unaffected offsprings connected within the matrilineal lineage and at-risk individual as a susceptible individual under the age of 25. The penetrance rates for family members by their relationship with the index patients were analyzed. The differences in penetrance rates by degree of relationship and sex were also investigated. Among the 32 families, 29 (90.6%) had the 11,778 mutation, while 3 (9.4%) had the 14,484 mutation. The average penetrance rates were 37.1% for male and 10.2% for female. For Koreans, one previous study reported a ratio of 1.6:1, and in the present study, the ratio was found to be 2.3:1. The total number of individuals at risk was 24 (10 males and 14 females). This study expands previous research by offering new information on the penetrance of LHON in the Korean population through pedigree analysis.
To evaluate the diagnostic performance of the endoscopic Jones (eJones) I and II tests in patients presenting with epiphora. A retrospective review was conducted of patients assessed for epiphora in a tertiary oculoplastic unit. All patients underwent rigid nasal endoscopy, dacryocystography (DCG), and dacryoscintigraphy (DSG). Lacrimal drainage status was categorized as nasolacrimal duct obstruction (NLDO), nasolacrimal duct stenosis (NLDS), or functional epiphora based on imaging findings. eJones I and II test outcomes were compared across diagnostic groups. Thirty-five symptomatic eyes were included. Functional epiphora was identified in 17 eyes, NLDO in 13 eyes, NLDS in one eye, and four eyes demonstrated normal lacrimal systems. All eyes with NLDO or NLDS had negative eJones I results, while all symptomatic eyes with normal imaging findings had positive eJones I results. Eyes with functional epiphora showed mixed eJones I outcomes. The eJones I test reliably confirmed anatomical obstruction but yielded variable results in cases of functional epiphora, highlighting the multifactorial mechanisms underlying this condition. Further studies are warranted to validate and refine the diagnostic utility of eJones testing.
To describe common ocular surface lesions that clinically mimic ocular surface squamous neoplasia (OSSN) and provide practical guidance for their accurate identification using anterior segment optical coherence tomography (AS-OCT). We thoroughly reviewed various ocular surface lesions, categorizing them based on etiology. Diagnostic features on clinical examination, histopathology, and characteristic imaging findings on AS-OCT were critically assessed. Numerous conditions can resemble OSSN, including corneal pannus, pseudopterygium, herpes simplex keratitis, conjunctival papilloma, trachoma, phlyctenulosis, pterygium, Salzmann nodular degeneration, conjunctival pyogenic granuloma, nevus, myxoma, schwannoma, Kaposi sarcoma, melanoma, lymphoma, sarcoidosis, and amyloidosis. Each of these lesions exhibits distinct imaging patterns on AS-OCT. OSSN uniquely demonstrates a hyperreflective thickened epithelium with a sharp transition between healthy and affected tissues, differentiating it clearly from other conditions. Accurate diagnosis of OSSN versus its clinical masqueraders remains challenging. AS-OCT is an invaluable, non-invasive tool to support clinicians in reliably distinguishing OSSN, guiding informed management decisions, and appropriate use of biopsy.
To report a case series of recurrent dacryocystitis following long-term lacrimal duct intubation, and to clarify the side effects of long-term lacrimal duct intubation. This study retrospectively evaluated 24 adults (27 eyes) who presented to our center between September 2019 and December 2024 with recurrent dacryocystitis following probing and subsequent stent intubation. Data collected included patient demographics, clinical presentation, duration of intubation, stent-related complications, computer tomography image, management strategies, and prognosis. Systematically reviewed randomized controlled trial articles on lacrimal duct intubation. Several stent-related complications were identified, including: punctal granuloma (11.1%, 3/27), stent fracture (11.1%, 3/27; all three fractured stents were plastic type, with fragments adherent to granulation tissue.), punctal laceration with recurrent extrusion (3.7%, 1/27; gold stent), soft tissue false passages (47.4%, 9/19), and bony false passages (7.4%, 2/27; cases with traumatic lacrimal obstruction). Among patients undergoing dacryocystorhinostomy, functional success was 81.48% (22/27) and anatomical success was 85.19% (23/27). Denominators vary across outcomes due to incomplete data availability for specific variables in the study cohort. This study emphasizes the importance of standardized operative techniques and appropriate duration of intubation to prevent complications associated with lacrimal stenting.
Acute Exudative Polymorphous Vitelliform Maculopathy (AEPVM) is a rare retinal disorder characterized by serous subretinal detachments that progress to vitelliform lesions. In this review, we aim to summarize current knowledge of etiologies and treatments for AEPVM and its association with primary and recurrent melanoma. We performed a comprehensive search of scientific literature for articles mentioning Acute Exudative Polymorphous Vitelliform Maculopathy including all literature published through March 2025 using the online electronic databases PubMed, MEDLINE, and Embase. We identified 81 cases (mean age 46 ± 16.9 years, 43.2% female) with etiologies including idiopathic (43), infectious (10), paraneoplastic (19), and medication-induced (9). Several successful treatments were identified. Local or systemic corticosteroids in 17 eyes improved subretinal fluid and vision in 100% of idiopathic, 50% of infectious, and 40% of medication-induced cases. In paraneoplastic AEPVM, fluid improved with immunotherapy (2 eyes), chemotherapy (2 eyes), intravitreal methotrexate (1 eye), and aflibercept (2 eyes). Notably, AEPVM was the initial symptom of primary or metastatic melanoma in 5 cases. The variable response to treatment and the potential link between AEPVM and primary and recurrent melanoma highlights the need for further research. A thorough understanding of treatment options and outcomes is essential to optimize management and to encourage prompt recognition of metastatic melanoma or other conditions associated with AEPVM.
Ocular cicatricial pemphigoid (OCP) is a chronic autoimmune condition characterized by recurrent conjunctival inflammation and progressive cicatrization, affecting nearly 70% of mucous membrane pemphigoid patients and potentially leading to blindness. Literature suggests an association between OCP and malignancy. This case series reports on 10 clinically diagnosed OCP patients with solid malignancies seen at the Illinois Eye and Ear Infirmary between January 2019 and January 2025. In addition, a review of current literature on the association between OCP and cancer was conducted using MEDLINE and Google Scholar databases. Six patients had an OCP diagnosis before their cancer diagnosis, three had a cancer diagnosis prior to OCP diagnosis, and one had both simultaneously. Patients diagnosed with cancer after OCP experienced clinically worsening OCP, while those with prior cancer diagnosis had stable OCP. Given the potential association with malignancy, patients with OCP or cicatricial conjunctivitis should undergo thorough systemic histories, age-appropriate cancer screenings, and patient education within a multidisciplinary care model to optimize early screening and improve the ocular and overall health outcomes.
A retrospective analysis of 44 TED patients (22 teprotumumab, 2023-2025 at Sheikh Shakhbout Medical City and 22 tocilizumab, 2018-2024 at Sheikh Khalifa Medical City) was conducted. Outcomes included proptosis reduction (Hertel exophthalmometry), clinical activity score (CAS) improvement, diplopia improvement, quality of life (QoL) improvement (TED-QOL), recurrence rates, and adverse events. Mann-Whitney U tests and chi-square/Fisher's exact tests were used (p < .05). Teprotumumab produced greater mean proptosis reduction (2.55 ± 1.01 mm vs 2.07 ± 1.07 mm, p = .04) and a larger mean CAS improvement (5.18 ± 1.99 vs 4.59 ± 1.82, p = .34). Diplopia improvement occurred in 78.6% vs 75.0% of patients (p = .82), while ≥1-grade improvement by Gorman criteria was achieved in 59.1% of each group (p = .61). Quality-of-life improvement averaged 4.2 ± 1.4 vs 3.4 ± 1.5 points (p = .18). Disease recurrence was lower with teprotumumab (4.5% vs 13.6%, p = .28). Adverse events occurred in 54.5% (teprotumumab) and 43.5% (tocilizumab) patients (p = .47), and were generally mild and reversible. Teprotumumab and tocilizumab improved TED outcomes, with teprotumumab showing trends toward better proptosis reduction and lower recurrence. Larger studies are needed to confirm these findings.
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