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Podcast Guests:

Dr. Evan Kalin-Hajdu - Assistant Professor of Ophthalmology at the University of Montreal. Dr. Kalin-Hajdu is the host of the current "Oculofacial Podcast Journal Club".

Dr. Bryan J. Winn - Professor of Ophthalmology and Vice Chair and Division Director for Oculofacial Plastic Surgery at UCSF. He also serves as the Chief of Ophthalmology at the San Francisco VA Healthcare System.

Dr. Davin Ashraf - Assistant Professor of Ophthalmology at Oregon Health & Science University (OHSU).

Dr. Kyle J. Godfrey - Assistant Professor of Ophthalmology at Weill Cornell Medicine and the New York Presbyterian Hospital. He is also the Director of the Ophthalmology Residency Program and a member of the Departments of Ophthalmology and Neurological Surgery.

Episode Summary:

Dr. Evan Kalin-Hajdu is joined by Dr. Bryan J. Winn, Dr. Davin Ashraf, and Dr. Kyle J. Godfrey to discuss three key articles from the May-June 2024 issue of the Ophthalmic Plastic and Reconstructive Surgery (OPRS) journal. Their discussions center on short-term versus long-term results of teprotumumab, a more tailored approach to the management of thyroid eye disease, and the nuances of increasingly popular transorbital surgery.

Dr. Winn begins by summarizing an article on teprotumumab for recalcitrant thyroid eye disease. The panelists then discuss the strengths and weaknesses of the paper, highlighting the medication's short-term effectiveness but raising concerns about its long-term durability. Dr. Ashraf then provides insights into a study that compared teprotumumab versus orbital decompression for thyroid eye disease, highlighting the likely additive effects of these combined treatments, but also raising compelling points about regression of proptosis that was only observed in the teprotumumab group. Dr. Godfrey then wraps up with an in-depth look at a novel transorbital endoscopic approach to the foramen rotundum for infraorbital nerve stripping, emphasizing the technique's potential utility, risks, and anatomical considerations.

Key Takeaways:

• Teprotumumab demonstrates significant short-term (3 weeks post treatment) efficacy in reducing proptosis and clinical activity scores in recalcitrant thyroid eye disease. However, data on long-term durability in this cohort remains unknown.
• Combining teprotumumab with orbital decompression may provide additive benefits for proptosis reduction. Surgical decompression provides the greatest proptosis reduction and does not appear to regress in time. However, patients treated solely with teprotumumab appear to regress within months of therapy.
• The participants discuss a more evidence-based approach to the management of thyroid eye disease, shifting away from the "one size fits all" model. The approach involves an effective short-term disease modulator, such as teprotumumab, followed by a more effective long-term disease modifier, such as tocilizumab or radiation therapy.
• Introducing a transorbital endoscopic approach for infraorbital nerve stripping could expand the surgical arsenal for managing complex orbital and perineural pathologies.