ISSN : 1300-2945
eISSN : 1308-9889
Özet - Clinical Results of Combined Systemic Steroid and Retroorbital Radiotherapy Treatment in Active Thyroid Associated Ophthalmopathy
Bilge Batu Oto, Didem Çolpan Öksüz, Seda Sert, Ömer Erol Uzel, Ahmet Murat Sarıcı

Bilge Batu Oto, Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Istanbul, Turkey e-mail: batubilge@gmail.com                                 

Clinical Results of Combined Systemic Steroid and Retroorbital Radiotherapy Treatment in Active Thyroid Associated Ophthalmopathy

Abstract

Objective: The aim of this study is to evaluate the efficacy of a different steroid dosage protocol which consists of intravenous pulse methylprednisolone combined with retroorbital radiotherapy in the treatment of active thyroid associated ophthalmopathy.

Methods: The medical records of 29 patients who were treated with a standard protocol and who were followed-up for at least 6 months were retrospectively analyzed. The treatment protocol consisted of intravenous pulse methylprednisolone 1gram/day for 3 consecutive days, followed by retroorbital radiotherapy. Oral prednisolone which was tapered over a 3-month course was given as a maintenance dose.

Results: 58 eyes of 29 patients were included in the study. Twelve patients were female (41%) and 17 were male (59%) with a mean age of 47.7 ± 12.6 years. The clinical activity score was 4.8 ± 1.3 and 2.8 ± 1.2, before and after treatment, respectively (P <0.05). 14 eyes (31%) had an improvement in best corrected visual acuity. In 28 eyes with had proptosis, proptosis regressed after treatment. Among 21 patients with diplopia, 13 (61%) patients reported an improvement in diplopia after treatment (P <0.05). None of our patients had any adverse event due to systemic steroid and retroorbital radiotherapy.

Conclusions: Pulse intravenously applied methylprednisolone for 3 days as 1 gram/day, combined with retroorbital radiotherapy proved to be effective in control of moderate to severe and active thyroid associated ophthalmopathy. In the 6-month follow-up significant decrease in clinical activity score and improvement in diplopia was observed in addition to improvement in best corrected visual acuity.

Keywords: Orbital radiotherapy; Thyroid ophthalmopathy; Graves’ disease

Aktif Tiroid Orbitopatide Kombine Sistemik Steroid ve Retroorbital Radyoterapi Tedavisinin Klinik Sonuçları

Öz

Amaç: Bu çalışmanın amacı, aktif tiroid orbitopati tedavisinde retroorbital radyoterapi ile kombine intravenöz pulse metilprednizolondan oluşan farklı bir steroid dozaj protokolünün etkinliğini değerlendirmektir.

Yöntemler: Belirlenmiş standart protokol ile tedavi edilen ve en az 6 ay takip edilen 29 hastanın tıbbi kayıtları retrospektif olarak incelendi. Tedavi protokolü arka arkaya 3 gün 1 gram/gün dozunda intravenöz pulse metilprednizolon ve ardından retroorbital radyoterapiden oluşuyordu. İdame dozu olarak oral prednizolon 3 ay süreyle ayda bir doz azaltılarak verildi.

Bulgular: 29 hastanın 58 gözü çalışmaya dahil edildi. 12 hasta (%41) kadın, 17 hasta (%59) erkekti ve ortalama yaşları 47,7 ± 12,6 idi. Klinik aktivite skoru tedaviden önce ve sonra sırasıyla 4.8 ± 1.3 ve 2.8 ± 1.2 idi (p <0.05). 14 gözde (%31) en iyi düzeltilmiş görme keskinliğinde iyileşme görüldü. Propitozisi bulunan 28 gözde tedavi sonrası propitozis geriledi. Diplopisi olan 21 hastadan 13'ü (%61) tedaviden sonra diplopide iyileşme bildirdi (p <0.05). Hiçbir hastamızda sistemik steroid tedavisine ve retroorbital radyoterapiye bağlı yan etki görülmedi.

Sonuç: Pulse intravenöz 3 gün süreyle 1 gram/gün dozunda uygulanan metilprednizolon, retroorbital radyoterapi ile kombine edildiğinde aktif tiroid orbitopatinin kontrolünde etkili oldu. 6 aylık takipte en iyi düzeltilmiş görme keskinliğinde düzelmenin yanı sıra klinik aktivite skorunda anlamlı azalma ve çift görmede düzelme izlendi.

Anahtar kelimeler: Orbital radyoterapi; tiroid orbitopati; Graves’ hastalığı

Dicle Med J  2023; 50 (2): 149-155

Doi: 10.5798/dicletip.1313177

 

Cilt 50, Sayı 2 (2023)