Extraocular muscle and orbital fat changes in treatment of thyroid eye disease with monoclonal antibodies: a systematic review and meta-analysis.

Authors

Alexander W C Kos, Angelica Hanna, Chris Zajner, Lulu L C D Bursztyn

Published in

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie. Aug 18, 2026. Epub Aug 18, 2026.

Abstract

To evaluate radiological changes in extraocular muscle (EOM) and orbital fat sizes in thyroid eye disease (TED) patients after receiving monoclonal antibody therapy.
The protocol was registered on PROSPERO (CRD420251129246). The electronic databases Embase (OVID), Medline, and PubMed were searched from inception to August 18, 2025, using keywords related to TED, EOMs, and monoclonal antibodies. Eligible studies reported baseline and follow-up imaging outcomes in monoclonal antibody-treated TED patients. Two reviewers independently conducted screening, data extraction, and RoB2 (or the revised Cochrane risk-of-bias tool for randomized trials) or ROBINS-I (or Risk of Bias in Non-randomized Studies-of Interventions) risk of bias assessment. Data were pooled using random-effects models to estimate mean differences in EOM and orbital fat volumes.
Fourteen studies were identified-3 randomized controlled trials, 4 retrospective cohort studies, and 7 prospective cohort studies-comprising 566 orbits from 304 TED patients. Pooled analysis revealed a total EOM volume mean difference of -1377 mm³ (95% CI: -2012 to -743; I² = 90.8%; p < .001), representing a 26.7% ± 7.0% reduction with treatment, and an orbital fat volume mean difference of -1732 mm³ (95% CI: -3002 to -461; I² = 82.8%; p < 0.001), representing a 16.2% ± 6.3% volume reduction with treatment. Cohen's-D effect sizes for individual EOM changes were superior rectus -0.67 (95% CI: -1.00 to -0.33; p < 0.01), inferior rectus -1.07 (95% CI: -1.89 to -0.25; p = 0.01), medial rectus -0.75 (95% CI: -1.12 to -0.37; p < 0.01), and lateral rectus -0.86 (95% CI: -1.53 to -0.18; p = 0.01).
Monoclonal antibody therapy is associated with significant EOM and orbital fat volume reductions in TED. Despite nonrandomization and heterogeneity limitations, these findings suggest that biologics improve clinical activity and remodel orbital soft tissues, supporting their role in disease modification.

PMID:
42612991
Bibliographic data and abstract were imported from PubMed on 19 Aug 2026.

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