{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:00:25Z","timestamp":1753891225594,"version":"3.41.2"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To assess differences in corneal morphology and biomechanics between patients with myopathic thyroid eye disease (TED) and normal controls (NCs), as well as to evaluate these changes following radiotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with active myopathic TED and age-, sex-, and spherical equivalent-matched NCs were enrolled in this study. All patients underwent radiotherapy and were followed up for 6 months post-treatment. Complete ophthalmic examinations were conducted for all subjects. Corneal morphology was evaluated using Pentacam, and biomechanics were assessed with Corvis ST tonometry, both before and 6 months post-radiotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This prospective, comparative clinical study involved 50 eyes from 50 TED patients and 30 eyes from 30 NCs. Post-radiotherapy, the intraocular pressure (IOP), proptosis, disease activity, diplopia, eye motility restriction and muscular index in TED patients significantly improved. Corneal morphological parameters such as elevation deviation, including back elevation (Db), pachymetric progression, relational thickness, overall deviation, and the index of surface variance, were significantly greater in TED patients compared to NCs, while Ambrosio\u2019s Relational Thickness maximum was significantly lower. After radiotherapy, Db decreased, and posterior surface astigmatism increased with statistical significance. Significant biomechanical changes were observed in patients with TED after adjustment with biomechanically corrected IOP, including reduced A2 time and peak distance, increased tomographic and biomechanical index (TBI), as well as diminished maximum whole eye movement length (WEML). Post-radiotherapy, a significant increase in WEML was observed. Correlation analysis suggested that improvements in ocular biomechanics may be linked to reductions in IOP and proptosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with myopathic TED demonstrated observable corneal alterations, including increased steepness, surface irregularity, reduced corneal hysteresis, and decreased orbital compliance. These biomechanical changes were associated with elevated TBI values, indicating heightened susceptibility to corneal ectatic disorders. Ocular biomechanical parameters may serve as as potential quantitative biomarkers for assessing treatment effectiveness in TED management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1612518","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T05:22:38Z","timestamp":1748928158000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiotherapy-induced changes in corneal morphology and biomechanics in myopathic thyroid eye disease"],"prefix":"10.3389","volume":"12","author":[{"given":"Pengsen","family":"Wu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Rao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shenglan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohan","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuqing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guiqin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1210\/edrv.21.2.0393","article-title":"Management of Graves\u2019 ophthalmopathy: Reality and perspectives.","volume":"21","author":"Bartalena","year":"2000","journal-title":"Endocr Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.canrad.2023.09.004","article-title":"Management of Graves\u2019 ophthalmopathy by radiotherapy: A literature review.","volume":"28","author":"Beige","year":"2024","journal-title":"Cancer Radiother."},{"key":"B3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1159\/000443828","article-title":"The 2016 European thyroid association\/European group on graves\u2019 orbitopathy guidelines for the management of graves\u2019 orbitopathy.","volume":"5","author":"Bartalena","year":"2016","journal-title":"Eur Thyroid J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1007\/s12020-024-03788-2","article-title":"Late orbital radiotherapy combined with intravenous methylprednisolone in the management of long-lasting active graves\u2019 orbitopathy: A case report and literature review.","volume":"85","author":"Verrienti","year":"2024","journal-title":"Endocrine."},{"key":"B5","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1056\/NEJMra0905750","article-title":"Graves\u2019 ophthalmopathy.","volume":"362","author":"Bahn","year":"2010","journal-title":"N Engl J Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/ICU.0b013e3283560b2b","article-title":"Orbital radiotherapy for thyroid eye disease.","volume":"23","author":"Dolman","year":"2012","journal-title":"Curr Opin Ophthalmol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1016\/s0161-6420(01)00632-7","article-title":"A prospective, randomized, double-blind, placebo-controlled study of orbital radiotherapy for Graves\u2019 ophthalmopathy.","volume":"108","author":"Gorman","year":"2001","journal-title":"Ophthalmology."},{"key":"B8","doi-asserted-by":"publisher","first-page":"101843","DOI":"10.1016\/j.clae.2023.101843","article-title":"Corneal topographic changes in patients with thyroid eye disease: A retrospective cross-sectional study.","volume":"46","author":"Chang","year":"2023","journal-title":"Cont Lens Anterior Eye."},{"key":"B9","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1167\/iovs.64.10.31","article-title":"The changes in ocular biomechanical response parameters and intraocular pressure after surgical treatment for thyroid eye disease.","volume":"64","author":"Hsia","year":"2023","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"16930","DOI":"10.1038\/s41598-024-68081-8","article-title":"Biomechanical changes of the cornea after orbital decompression in thyroid-associated orbitopathy measured by corvis ST.","volume":"14","author":"Soleymanzadeh","year":"2024","journal-title":"Sci Rep."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1136\/bjophthalmol-2016-309532","article-title":"In vivo ocular biomechanical compliance in thyroid eye disease.","volume":"101","author":"Vellara","year":"2017","journal-title":"Br J Ophthalmol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"3615","DOI":"10.1007\/s10792-023-02770-7","article-title":"Evaluation of orbital soft tissue biomechanical parameters in patients with thyroid eye disease using the non-contact Corvis ST.","volume":"43","author":"Moeen Rad","year":"2023","journal-title":"Int Ophthalmol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"104127","DOI":"10.1016\/j.jaapos.2025.104127","article-title":"Progression of keratoconus secondary to thyroid eye disease: A case report.","volume":"29","author":"Carbonell","year":"2025","journal-title":"J Am Assoc Pediatr Ophthalmol Strabis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1177\/11206721241235984","article-title":"Estimated prevalence of keratoconus in the largest metropolitan area of Italy.","volume":"34","author":"Lombardo","year":"2024","journal-title":"Eur J Ophthalmol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1007\/s40618-020-01322-5","article-title":"Changes in ocular biomechanics after treatment for active Graves\u2019 orbitopathy.","volume":"44","author":"Li","year":"2021","journal-title":"J Endocrinol Invest."},{"key":"B16","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1097\/01.icl.0000152486.36121.db","article-title":"Corneal topography in thyroid orbitopathy after orbital irradiation.","volume":"31","author":"Iskeleli","year":"2005","journal-title":"Eye Contact Lens."},{"key":"B17","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/j.ophtha.2021.10.025","article-title":"Orbital radiation for thyroid eye disease: A report by the American academy of ophthalmology.","volume":"129","author":"Sobel","year":"2022","journal-title":"Ophthalmology."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/j.ijrobp.2010.09.015","article-title":"Protracted hypofractionated radiotherapy for Graves\u2019 ophthalmopathy: A pilot study of clinical and radiologic response.","volume":"82","author":"Cardoso","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys."},{"key":"B19","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1097\/01.iop.0000235499.34867.85","article-title":"Classification for Graves orbitopathy.","volume":"22","author":"Dolman","year":"2006","journal-title":"Ophthalmic Plast Reconstr Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.ophtha.2011.07.011","article-title":"Reliability of estimating ductions in thyroid eye disease: An International thyroid eye disease society multicenter study.","volume":"119","author":"Dolman","year":"2012","journal-title":"Ophthalmology."},{"key":"B21","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1007\/s11604-019-00846-y","article-title":"Improvement of the MRI and clinical features of Asian Graves\u2019 ophthalmopathy by radiation therapy with steroids.","volume":"37","author":"Ma","year":"2019","journal-title":"Jpn J Radiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1097\/ico.0000000000003357","article-title":"Corneal morphological and biomechanical changes in thyroid-associated ophthalmopathy.","volume":"43","author":"Zhang","year":"2024","journal-title":"Cornea."},{"key":"B23","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1167\/iovs.16-21045","article-title":"Factors associated with corneal deformation responses measured with a dynamic scheimpflug analyzer.","volume":"58","author":"Miki","year":"2017","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.beem.2011.11.007","article-title":"Evaluating Graves\u2019 orbitopathy.","volume":"26","author":"Dolman","year":"2012","journal-title":"Best Pract Res Clin Endocrinol Metab."},{"key":"B25","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1159\/000348246","article-title":"Differential involvement of orbital fat and extraocular muscles in Graves\u2019 ophthalmopathy.","volume":"2","author":"Wiersinga","year":"2013","journal-title":"Eur Thyroid J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1097\/iop.0000000000001150","article-title":"Grading severity and activity in thyroid eye disease.","volume":"34","author":"Dolman","year":"2018","journal-title":"Ophthalmic Plast Reconstr Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1007\/s00417-014-2708-1","article-title":"Simultaneous study of matrix metalloproteinases, proinflammatory cytokines, and soluble cytokine receptors in the tears of noninfectious corneal ulcer patients.","volume":"252","author":"Sakimoto","year":"2014","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"4574","DOI":"10.1167\/iovs.10-5380","article-title":"Corneal involvement in Graves\u2019 orbitopathy: An in vivo confocal study.","volume":"51","author":"Villani","year":"2010","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1080\/02713683.2017.1405044","article-title":"Measurement of orbital biomechanical properties in patients with thyroid orbitopathy using the dynamic scheimpflug analyzer (Corvis ST).","volume":"43","author":"Leszczynska","year":"2018","journal-title":"Curr Eye Res."},{"key":"B30","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12886-019-1064-7","article-title":"A novel method for quantifying the biomechanical parameters of orbital soft tissue using a corneal dynamic scheimpflug analyser: A retrospective study.","volume":"19","author":"Hwang","year":"2019","journal-title":"BMC Ophthalmol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"4305","DOI":"10.1007\/s10792-023-02842-8","article-title":"Changes in therapeutic response, ocular manifestations of Graves\u2019 orbitopathy and quality of life during the first year after orbital radiotherapy.","volume":"43","author":"Stoynova","year":"2023","journal-title":"Int Ophthalmol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"S98","DOI":"10.1097\/iop.0000000000001074","article-title":"Radiotherapy for active thyroid eye disease.","volume":"34","author":"Godfrey","year":"2018","journal-title":"Ophthalmic Plast Reconstr Surg."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1177\/02841851211034042","article-title":"Evaluation of extraocular muscles in patients with thyroid associated ophthalmopathy using apparent diffusion coefficient measured by magnetic resonance imaging before and after radiation therapy.","volume":"63","author":"Yu","year":"2022","journal-title":"Acta Radiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.1007\/s00417-009-1144-0","article-title":"Intraocular pressure and superior ophthalmic vein blood flow velocity in Graves\u2019 orbitopathy: Relation with the clinical features.","volume":"247","author":"Konuk","year":"2009","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1016\/j.ajo.2008.02.019","article-title":"Effect on intraocular pressure of extraocular muscle surgery for thyroid-associated ophthalmopathy.","volume":"145","author":"Danesh-Meyer","year":"2008","journal-title":"Am J Ophthalmol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1111\/ceo.12400","article-title":"Twenty-four-hour intraocular pressure patterns in patients with thyroid eye disease.","volume":"43","author":"Parekh","year":"2015","journal-title":"Clin Exp Ophthalmol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"219","DOI":"10.3109\/01676830.2013.788663","article-title":"Effect of radiation therapy on intraocular pressure in patients with Graves\u2019 orbitopathy.","volume":"32","author":"Russell","year":"2013","journal-title":"Orbit."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1612518\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T05:22:38Z","timestamp":1748928158000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1612518\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":37,"alternative-id":["10.3389\/fmed.2025.1612518"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1612518","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,6,3]]},"article-number":"1612518"}}