Photodiagnosis and photodynamic therapy · 2025
Integrating novel OCT-based choroidal imaging: A multimodal nomogram for predicting intravenous glucocorticoid response in thyroid-associated ophthalmopathy.
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Wang Yinru, Song Qinglu, Zhang Zhiyuan, Wu Huihui, Su Mengru, Sun Xinghong
Аннотация
PURPOSE: This study aimed to develop a clinically accessible, cost-effective nomogram model to predict intravenous glucocorticoid (IVGC) response in active moderate-to-severe thyroid-associated ophthalmopathy (TAO) by integrating novel optical coherence tomography (OCT)-derived choroidal parameters, thereby addressing limitations of existing biomarkers tied to specialized infrastructure and high costs.
METHODS: A retrospective analysis included 90 patients (178 eyes) with active moderate-to-severe TAO treated with IVGC per EUGOGO guidelines. Clinically routine parameters, specifically thyrotropin receptor antibody (TRAb), total cholesterol (TC), lymphocyte-to-monocyte ratio (LMR), and OCT-derived subfoveal choroidal thickness (SFCT), were analyzed via multivariate logistic regression. Model performance was evaluated using ROC analysis, 1000-bootstrap validation, and calibration curves.
RESULTS: Elevated TRAb (OR = 0.95, P = 0.005), TC (OR = 0.155, P < 0.001), LMR (OR = 0.709, P = 0.006), and reduced SFCT (OR = 0.983, P < 0.001) independently predicted IVGC response. The nomogram showed high accuracy (AUC = 0.926, 95 % CI: 0.880-0.962) and robust calibration. These biomarkers collectively reflect autoimmune dysregulation, lipid-mediated inflammation, and fibrotic remodeling, underlying therapeutic resistance.
CONCLUSION: The developed nomogram effectively integrates the capabilities of optical coherence tomography (OCT) and routine biomarkers to provide a precise, cost-effective, and accessible strategy for predicting IVGC treatment response in TAO. This tool empowers clinicians to guide therapeutic personalization, thereby optimizing patient outcomes and minimizing the risks associated with ineffective therapy.
METHODS: A retrospective analysis included 90 patients (178 eyes) with active moderate-to-severe TAO treated with IVGC per EUGOGO guidelines. Clinically routine parameters, specifically thyrotropin receptor antibody (TRAb), total cholesterol (TC), lymphocyte-to-monocyte ratio (LMR), and OCT-derived subfoveal choroidal thickness (SFCT), were analyzed via multivariate logistic regression. Model performance was evaluated using ROC analysis, 1000-bootstrap validation, and calibration curves.
RESULTS: Elevated TRAb (OR = 0.95, P = 0.005), TC (OR = 0.155, P < 0.001), LMR (OR = 0.709, P = 0.006), and reduced SFCT (OR = 0.983, P < 0.001) independently predicted IVGC response. The nomogram showed high accuracy (AUC = 0.926, 95 % CI: 0.880-0.962) and robust calibration. These biomarkers collectively reflect autoimmune dysregulation, lipid-mediated inflammation, and fibrotic remodeling, underlying therapeutic resistance.
CONCLUSION: The developed nomogram effectively integrates the capabilities of optical coherence tomography (OCT) and routine biomarkers to provide a precise, cost-effective, and accessible strategy for predicting IVGC treatment response in TAO. This tool empowers clinicians to guide therapeutic personalization, thereby optimizing patient outcomes and minimizing the risks associated with ineffective therapy.