Abstract

SO.08.02

Clinical course of ocular symptoms and motility after combined intravenous corticosteroids and orbital radiotherapy in patients with Graves’ orbitopathy

Ina Sterker1, Helmut Tegetmeyer1, Kirsten Papsdorf2, Dagmar Führer-Sakel3
1Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Leipzig; 2Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig, Leipzig; 3Medizinische Klinik und Poliklinik III/Endokrinologie, Diabetologie und Nephrologie, Universitätsklinikum Leipzig, Leipzig

Objective
Graves’ orbitopathy (GO) in it`s moderate-to-severe expression it`s a disfigurating and disabling disease that profoundly influences daily life activities.  Intravenous glucocorticoids and orbital radiotherapy represent effective treatments for moderate-to-severe, active Graves’ orbitopathy. We examined the ophthalmological outcome in all ocular symptoms and motility.
Methods
Materials and methods: In a retrospective case series 23 consecutive patients with moderate-to-severe, active GO (14 women and 7 men) were treated with combined orbital radiotherapy (13 Gy) and intravenous methylprednisolone (500 mg weekly infusions for 6 consecutive weeks and 250 mg weekly for consecutive 6 weeks).
Results
Results: The pre-treatment mean Clinical Activity Score (CAS) of 5.2 points (SD ±0.9) decreased significantly to 2.7 points (SD ±1.1) in the 12 month follow-up. Analysis of all ocular symptoms included in the CAS showed significant changes for six parameters in different time frames. Inflammatory eye signs, e.g. pain and pressure sensation, caruncle inflammation, eyelid redness, including visual acuity and exophthalmos improved significantly within the first three months. Eyelid swelling was significantly reduced 6 to 12 months after start of therapy. However, there was no significant improvement of eye motility. Despite anti-inflammatory treatment, 13 patients (61.9 %) were not fit to drive a car under binocular conditions and additional strabismologic therapy including prisms and strabismus surgery was required.
Conclusions
Conclusion: The combined therapy of intravenous methylprednisolone and orbital radiotherapy reduced inflammatory ophthalmological signs in different time frames. In most cases strabismologic intervention including eye muscle surgery was necessary to restore driving competence.

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