Work

Integrating novel OCT-based choroidal imaging: A multimodal nomogram for predicting intravenous glucocorticoid response in thyroid-associated ophthalmopathy

Year: 2025

Type: article

Abstract: • The first multimodal nomogram integrating thyroid function (TRAb), lipid metabolism (total cholesterol), systemic inflammation (LMR), and OCT-derived choroidal parameters (SFCT) for predicting IVGC resistance in active moderate-to-severe TAO. • Statistically validated high-accuracy predictions achieved by this model showing marked advantages over infrastructure-intensive conventional biomarker paradigms. • Clinically actionable tool utilizing routine parameters, enabling cost-effective risk stratification to minimize steroid toxicity and guide early intervention. • Pathophysiological insights linking glucocorticoid resistance to autoimmune dysregulation (TRAb), lipid-driven inflammation (cholesterol), and fibrotic remodeling (SFCT). 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. 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. 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. 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.

Source: Photodiagnosis and Photodynamic Therapy

DOI: 10.1016/j.pdpdt.2025.105282

Authors: Yinru Wang, Qinglu Song, Zhiyuan Zhang, Huihui Wu, Mengru Su, Xinghong Sun

Institutions: Nanjing Drum Tower Hospital, Nanjing University, Jiangsu Province Hospital, Jiangsu Province Development and Reform Commission

Language: English

Topic: Ophthalmology and Eye Disorders

Subfield: Pathology and Forensic Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,610