Purpose. Graves’ ophthalmopathy (GO) is the most frequent extra‑thyroidal expression of Graves’ disease. Data reported in the literature on outcomes following the most widely used treatments for this condition, glucocorticoids (GC) and radiotherapy (RT), vary greatly. We therefore made a retrospective study on 112 patients to evaluate the efficacy of these two treatments when used as a single or combined modality. Patients and methods. Forty-eight patients received RT combined with GC, 28 patients oral high-dose GC, and 36 patients oral low-dose GC. A comparative study was made of effect of the treatments on soft tissue alterations, proptosis, extraocular motility and visual acuity after 6 months. Results. After RT combined with GC, a significant improvement was observed in soft tissue alterations, with an overall improvement in 58,3% of patients. In the high‑dose and low‑dose GC groups, no significant changes were observed; overall, an improvement was found in 42.9% of the high‑dose GC patients, and in 27.7% of the low-dose GC group, although this difference was not of statistical significance. On comparing treatments, RT combined with GC was found to be significantly more effective than the other approaches. Conclusions. At a follow‑up of 6 months, better results were obtained with RT combined with low‑dose GC, with an efficacy of 58.3%, in agreement with findings made by other Authors, and only on soft tissues changes. Reduction of the Clinical Activity Score confirmed these results. Neither of the groups of patients who underwent only steroidal therapy significant improvements in ocular signs, probably because GC have less lasting effects than RT. It should, however, be borne in mind that modifications in various parameters can depend on the natural history of GO. Ottica Fisiopat 2007; XII :
Oftalmopatia di Graeves: Studio retrospettivo sull'efficacia della radioterapia e dei glucocorticoidi.
PERRONE, SALVATORE;
2007
Abstract
Purpose. Graves’ ophthalmopathy (GO) is the most frequent extra‑thyroidal expression of Graves’ disease. Data reported in the literature on outcomes following the most widely used treatments for this condition, glucocorticoids (GC) and radiotherapy (RT), vary greatly. We therefore made a retrospective study on 112 patients to evaluate the efficacy of these two treatments when used as a single or combined modality. Patients and methods. Forty-eight patients received RT combined with GC, 28 patients oral high-dose GC, and 36 patients oral low-dose GC. A comparative study was made of effect of the treatments on soft tissue alterations, proptosis, extraocular motility and visual acuity after 6 months. Results. After RT combined with GC, a significant improvement was observed in soft tissue alterations, with an overall improvement in 58,3% of patients. In the high‑dose and low‑dose GC groups, no significant changes were observed; overall, an improvement was found in 42.9% of the high‑dose GC patients, and in 27.7% of the low-dose GC group, although this difference was not of statistical significance. On comparing treatments, RT combined with GC was found to be significantly more effective than the other approaches. Conclusions. At a follow‑up of 6 months, better results were obtained with RT combined with low‑dose GC, with an efficacy of 58.3%, in agreement with findings made by other Authors, and only on soft tissues changes. Reduction of the Clinical Activity Score confirmed these results. Neither of the groups of patients who underwent only steroidal therapy significant improvements in ocular signs, probably because GC have less lasting effects than RT. It should, however, be borne in mind that modifications in various parameters can depend on the natural history of GO. Ottica Fisiopat 2007; XII :
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