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Presentation type	E-poster
Title	Improvement of Chorioretinal Folds after Teprotumumab in Severe Graves’ Orbitopathy

Purpose	We report the case of a male in his forties, non-smoker, with biochemically proven active Graves’ orbitopathy (GO), with a clinical activity score (CAS) of 5/7 in the right and 1/7 in the left eye. Despite prompt treatment with thiamazole, β-blockers, selenium supplementation and intravenous methylprednisolone according to the EUGOGO guidelines, refractory disease was noted in the right eye, with a marked increase in swelling and proptosis, and a new finding of “curtain”-like, resulting in new onset metamorphopsia and visual loss. It is postulated that a combination of inflammation and choroidal venous congestion causes folding over Bruch’s membrane. Chorioretinal folds are a rare complication of GO, with only a handful of reported cases.
Methods	Because the patient preferred a deferral of orbital decompression, teprotumumab (TEPEZZA®), a novel insulin-like growth factor I receptor (IGF-IR) inhibitor, was initiated as second line treatment with four injections spaced three weeks apart.
Results	Preliminary results showed marked improvement in proptosis, CAS, metamorphopsia and vision with regression of chorioretinal folds. Therapy is well tolerated, with only mild hyperglycemia on the day of injection as a side effect. No hearing impairment was reported during treatment.
Conclusion	This case highlights the efficacy and excellent tolerance of teprotumumab (TEPEZZA®) in treating a severe GO presenting with a rare complication of chorioretinal folds.
Conflict of interest	No

Authors 1

Last name	JOOS
Initials	B
Department	Universitair Ziekenhuis Gent
City	Gent

Authors 2

Last name	Van Haecke
Initials	H
Department	Goes Oogcentrum
City	Antwerp

Authors 3

Last name	Van den Bruel
Initials	A
Department	AZ Sint-Jan
City	Brugge

Authors 4

Last name	Vandelanotte
Initials	S
Department	AZ Sint-Jan
City	Brugge