Research and Publications

Abstract

To evaluate the incidence and characteristics of menstrual changes associated with teprotumumab treatment for thyroid eye disease (TED).A retrospective chart review of female patients receiving teprotumumab treatment was performed across three institutions between 1/2020 and 12/2023. Data collection included age, thyroid status, hormonal contraception use, pre- and post-treatment clinical activity score, adverse events, and type of menstrual changes. If menstrual changes occurred, further data collection included onset and duration of menstrual changes.Fifty-one patients were included with a mean age of 37 years (range 18-51). Changes in menstruation occurred in 28 patients (55%). Among these patients, 21 (75%) had amenorrhea, 6 (21%) had oligomenorrhea, and 1 (4%) had dysmenorrhea. The average number of days between first infusion and first change in menstruation was 58 days (range 7-150), and between last infusion and return to normal menstruation was 155 days (range 6-405). Four patients (14%) did not have a return to normal menstruation at time of last follow-up (mean 9 months, range 6-11 months). Overall mean follow-up was 16 months after last infusion.Menstrual changes occurred in 55% of menstruating females receiving teprotumumab therapy. The most common changes were amenorrhea and oligomenorrhea. The majority of patients regained normal menstruation after cessation of therapy. It is important for providers to be aware of this potential adverse event when treating menstruating women with TED.

View details for DOI 10.1080/01676830.2025.2609906

View details for PubMedID 41528831

View details for DOI 10.1227/ons.0000000000001882

View details for PubMedID 41460689

Abstract

While bisphosphonates are widely used to treat osteoporosis, ocular adverse effects (OAEs) and their associations with serious systemic side effects, such as osteonecrosis, remain unexplored in large, diverse cohorts.Retrospective cohort study from a deidentified aggregated multinational electronic health records database. Patients were included based on no prior recorded history of OAEs, recorded prescription of bisphosphonates and a subsequent visit. The risk of osteonecrosis for patients with and without OAEs after bisphosphonate initiation was assessed. Propensity score matching was used to control for demographic factors and prior autoimmune conditions. Rates of OAEs were compared between patients on intravenous or oral bisphosphonates.A cohort of 944,559 patients was identified. The cohort mean age was 75 years. The most common OAEs were dry eyes (1.73%), cornea and ocular surface inflammation (0.97%), and uveitis (0.17%). Patients with any OAEs with bisphosphonate use compared to those without OAEs had an increased risk of osteonecrosis (RR: 1.48, (1.30, 1.93)), with the highest increased risk for zoledronate (RR: 2.22, (1.63-3.03)). Furthermore, intravenous bisphosphonates compared to oral bisphosphonates had an increased risk of dry eyes (RR: 1.27 (1.20, 1.36)) at all timepoints.Although rarer than reported in literature, our large cohort size revealed that patients on bisphosphonates with OAEs had an increased risk of osteonecrosis compared to those without OAEs. Patients on intravenous compared to oral bisphosphonates were at increased risk for OAEs. These findings guide ophthalmologists to identify OAEs from bisphosphonate use and to be vigilant for increased risks of systemic side effects.

View details for DOI 10.1038/s41433-025-04185-3

View details for PubMedID 41454062

View details for PubMedCentralID 4652608

Abstract

Background: The treatment paradigm for thyroid eye disease (TED) in the United States has shifted from corticosteroids toward targeted therapies such as teprotumumab. However, it remains unknown whether teprotumumab decreases the need for subsequent treatments for TED compared with intravenous methylprednisolone (IVMP). This study compares the long-term need for additional medical or surgical interventions in TED patients treated with teprotumumab versus IVMP. Methods: A retrospective cohort study identified TED patients treated with IVMP or teprotumumab utilizing the TriNetX Analytics platform. Patients with comorbidities requiring high-dose steroids, prior TED therapy within 6 months, or concurrent TED treatments were excluded. Propensity score matching (PSM) adjusted for baseline demographic and TED-related risk factor differences. Patients were followed for 6, 12, and 18 months after a 6-month washout period. The primary outcome was the incidence of additional TED-related interventions. Secondary outcomes included post-treatment care trajectories, treatment burden, and complexity, assessed through longitudinal pathway analysis. Results: The IVMP cohort included 308 patients, and the teprotumumab cohort included 417; after PSM, each contained 263 patients. No significant differences were found in the incidence of additional TED-related interventions between cohorts. A similar percentage required additional medical therapies (41% vs. 37%, p = 0.423), while fewer in the IVMP cohort underwent additional surgical interventions (3.8% vs. 8.8%, p = 0.019, 4.8% vs. 10.0%, p = 0.040) at 12 and 18 months. Among those needing additional TED interventions, the IVMP cohort exhibited a higher treatment burden and more complex treatment trajectories, requiring a greater average number of treatments (2.34 vs. 1.34 per patient; 32.8% vs. 5.5% requiring ≥3 additional treatments). Conclusions: TED patients treated with IVMP or teprotumumab had similar overall rates of additional interventions. However, IVMP was associated with greater treatment complexity, requiring more varied medical therapies. Teprotumumab-treated patients typically required fewer additional medical therapies and underwent more surgical interventions as a second-line step, suggesting that teprotumumab may simplify the treatment pathway. These data have important implications for patient education and future assessment of the cost-effectiveness of TED therapies.

View details for DOI 10.1177/10507256251408731

View details for PubMedID 41467905

Abstract

To explore health outcomes of patients with ulcerative colitis (UC) and associated ocular inflammatory disease, compared to those of matched patients with UC without associated ocular inflammatory disease.Retrospective case-control study.An aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with UC stratified by the presence or absence of ocular inflammatory disease with at least one year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities.Rates and relative risk (RR) of developing various forms of intestinal complications, extraintestinal morbidities, rheumatologic disease, cardiovascular disease, and death.Patients with UC with associated ocular inflammatory disease showed greater risk of undergoing total colectomy, as well as acquiring Clostridioides difficile and CMV colitis. They also demonstrated a greater risk of developing MASLD, vitamin D deficiency, iron deficiency anaemia, UC-related dermatological disease, osteoporosis, and sepsis. These individuals were more likely to carry rheumatologic diagnoses, including ankylosing spondylitis, psoriatic, rheumatoid, enteropathic, reactive, and inflammatory arthritis. There was an elevated risk of stroke, myocardial infarction, and VTE in this cohort as well. There was no significant difference in risks of colorectal cancer, primary sclerosing cholangitis, toxic megacolon, non-radiographic axial spondyloarthritis, or mortality between the cohorts.Patients with UC with ocular inflammatory disease have an increased risk of intestinal complications, extraintestinal morbidity, rheumatologic disease, and cardiovascular complications when compared to those without.

View details for DOI 10.1038/s41433-025-04151-z

View details for PubMedID 41345346

View details for PubMedCentralID 3959315

Abstract

XXX.

View details for DOI 10.1016/j.ajo.2025.11.013

View details for PubMedID 41253212

Abstract

Discerning glaucoma in myopic eyes with tilted optic nerve discs is challenging given the atypical appearance and segmentation on optical coherence tomography. This study aims to determine the association between retinal sequelae of myopia and primary open-angle glaucoma (POAG). We hypothesize that retinal sequelae of myopia may aid in identifying high-risk glaucoma patients.An aggregated electronic health records research network was used to retrospectively identify 929,142 myopic patients. We evaluated the association of POAG with retinal sequelae of myopia, including choroidal neovascularization (CNV), myopic macular degeneration (MMD), foveoschisis, macular hole (MH), rhegmatogenous retinal detachment (RRD), and foveal retinal detachment (FRD). Logistic regressions estimated odds ratios (adjusted for age, sex, race, and ethnicity). Cox models estimated hazard ratios (additionally adjusted for pseudophakia).FRD exhibited the strongest association with POAG (AOR: 5.82; 95% CI: 3.44-9.85), followed by foveoschisis (AOR: 3.10; 95% CI: 1.84-5.21) and MMD (AOR: 2.87; 95% CI: 2.19-3.75). Severe subtypes of POAG were also more highly associated with each retinal sequela than moderate and milder severity subtypes. Additionally, patients with each retinal sequela experienced a significantly faster progression from glaucoma suspect to POAG than those without these sequelae. Kaplan-Meier curves and adjusted Cox regression models suggested a faster progression from glaucoma suspect to POAG in those with foveoschisis (HR: 5.33; 95% CI: 2.21-12.85; p<0.005), CNV (HR: 1.73; 95% CI: 1.12-2.67; p=0.01), MMD (HR: 2.74; 95% CI: 1.47-5.10; p<0.005), MH (HR: 1.73; 95% CI: 1.29-2.31; p<0.005), and RRD (HR: 1.54; 95% CI: 1.28-1.86; p<0.005), whereas FRD was not significantly associated with glaucoma progression (HR: 1.28; 95% CI: 0.18-9.10; p=0.8).The retinal sequelae of myopia are associated with the presence and progression of primary open-angle glaucoma. The presence of the retinal sequelae of myopia should cue ophthalmologists to refer such patients for glaucoma evaluation to encourage earlier detection and more targeted management.

View details for DOI 10.2147/OPTH.S542692

View details for PubMedID 41103309

View details for PubMedCentralID PMC12523566

Abstract

To evaluate the association between exogenous testosterone (ExoT) use and central serous chorioretinopathy (CSCR).Retrospective observational cohort study using large-scale electronic health record (EHR) data.Patients receiving exogenous testosterone therapy, identified from the MarketScan and STARR databases.Data were accessed from two sources: Merative™ MarketScan® Commercial Database, and Stanford's Clinical Data Warehouse (STARR), which aggregates de-identified patient records from Stanford Health Care. Patients on testosterone therapy were included and categorized by CSCR status. Demographic factors such as sex (administrative field), race, and ethnicity were assessed. Laboratory values (testosterone, hematocrit, RBC count, cortisol) were compared in STARR, with limited availability in MarketScan. Logistic regression analyses were performed in MarketScan adjusting for age and sex. A sensitivity analysis restricted to patients exposed to ExoT prior to CSCR diagnosis was also performed.The primary outcomes were CSCR prevalence and adjusted odds ratios (AOR) for CSCR risk in patients on exogenous testosterone. Secondary outcomes included differences in laboratory values and treatment requirements (photodynamic therapy [PDT] and intravitreal injections).In STARR, individuals with CSCR on exogenous testosterone had significantly higher mean testosterone levels (p=0.001), hematocrit (p=0.022), and RBC counts (p=0.005) compared to those without CSCR. In MarketScan, laboratory values trended in the same direction but were not statistically significant, likely reflecting limited sample sizes. Logistic regression in MarketScan showed that exogenous testosterone was significantly associated with increased CSCR risk (AOR: 8.05; 99% CI: 6.04-10.73). In both datasets, there were no significant differences in treatment rates (PDT or intravitreal injections) between ExoT and non-ExoT users. In a sensitivity analysis restricted to patients who received ExoT prior to CSCR diagnosis, no significant laboratory differences were observed.This study demonstrates a significant association between exogenous testosterone use and increased CSCR risk, highlighting the importance of monitoring patients on testosterone therapy for potential ocular symptoms, especially among high-risk demographic groups.

View details for DOI 10.1016/j.ajo.2025.09.044

View details for PubMedID 41047110