Background. Computed tomography (CT) allows visualizing the bone and soft tissue structures of the orbit in a three-dimensional projection, fixing the position of the eyeball and determining the causes of the development of exophthalmos. The aim of the study was to develop an algorithm for CT diagnostics of exophthalmos in patients with endocrine ophthalmopathy. Material and methods. CT with determination of bone and soft tissue structures of the orbits in three-dimensional projection was performed in 90 patients with image intensifier, whose exophthalmometry data exceeded 18mm. Considering the presence of clinical signs of the disease, they were subdivided into two groups: Group I (n=42) - patients with exophthalmos without classical EOP symptoms with exophthalmometry in the range of ≥ 18 to ≤23mm; Group II (n = 48) - patients with exophthalmos accompanied by classical EOP symptoms, whose exophthalmometry was more than 23mm. Results. The indicators were revealed that characterize the anatomical features of the bone part of the orbital complex, with a deviation from which the risk of developing exophthalmos is much higher and its clinical manifestation, associated with changes in intraorbital structures (thickness and density of muscles and retrobulbar tissue), is much higher and more severe. Conclusions. The data obtained made it possible to develop an algorithm for diagnosing exophthalmos with image intensifier and to propose a set of rational organizational measures and diagnostic techniques for its timely detection and establishment of a clinical and functional diagnosis at the stage of outpatient and / or inpatient care, as well as substantiation of the treatment method.

Background. Pathogenetic therapy of the moderate severity endocrine ophthalmopathy (EOP) is performed by the administration of glucocorticoids (GC), which possess immunosuppressive, anti-inflammatory and anti-edematous effects. Currently, the application of selenium and pentoxifylline medications, as well as treatment with magnetic field over periorbital region are considered as a part of combined therapy for the disease. Purpose of the study. To evaluate the results of combined conservative treatment of patients with moderate severity EOP. Material and methods. The study included 25 patients (50 orbits) with the clinical signs of moderate severity EOP. Depending on the treatment regimen, patients were divided into group A (comparison) and group B (main). Group A (comparison) – 10 patients who received pulse therapy with methylprednisolone. Group B (main) – 15 patients who were prescribed a combination of pulse therapy with methylprednisalone and a new developed treatment regimen additionally: selenium 100 mgq 2 times a day for 6 months, pentoxifylline at a dose of 600 mg 2 times a day for 6 months, a low-frequency pulsed magnetic field generated by the "UniSPOK" apparatus, lasting for 10-20 minutes, up to 8-12 procedures performed daily. Methylprednisolone application in the form of intravenous pulse therapy was prescribed collegially by an endocrinologist and an ophthalmologist individually for each patient and in total did not exceed 4.5 g recommended for the present process intensity (on average, 4.5±0.5 g in both groups). Results. The sequence in decreasing of EOP clinical signs in patients receiving combination therapy was revealed: a decrease in tremor, eyelid edema and palpebral fissure width in comparison with the initial parameters were noted already by the 3rd month of treatment, after 6 months these indicators disappeared. Lacrimation in the studied groups was not recorded by the 6th month, which can be explained by the corticosteroids application. A significant reduction in exophthalmos under developed therapy was found after 6 months, while no reduction was observed in the standard treatment group. Conclusions. The method of EOP complex treatment, including pulse therapy with methylprednisolone in combination with selenium, pentoxifylline and magnetotherapy, was effective in the moderate severity of the disease and led to the reduction of the ophthalmopathy severity symptoms. The positive effect of the combined therapy indicates the necessity for a six-month treatment course.

Введение. Достижения современной медицины способствуют своевременной диагностике эндокринной офтальмопатии (ЭОП). Однако лечение продолжает оставаться сложной задачей, результаты которого не удовлетворяют врача и пациента. Цель исследования-оценка эффективности и безопасности лечения пациентов с эндокринной офтальмопатией путем выбора лечебной тактики в зависимости oт клинических проявлений заболевания. Материал и методы. Проведён анализ эффективности лечения 36 пациентов средней тяжести ЭОП пульс-терапией метилпреднизолоном. Минимальная кумулятивная доза препарата составила 4,5 г. Результаты. Снижение активности ЭОП по шкале CAS и уменьшение выраженности воспалительных изменений со стороны мягких тканей орбиты наблюдалось через 1 месяц от начала введения препарата. После отмены пульс-терапии полученный положительный эффект сохранялся у 29 из 36 положительно ответивших пациентов, что составило 80,6%. Ухудшение течения офтальмопатии по окончании курса лечения зафиксировано у 7 пациентов (19,4%), из них табакокурение отмечено у 5 (71,4%), нестабильность гормонального состояния с последующей коррекцией назначений эндокринологом наблюдалась у 2 (28,65%) пациентов. Выводы. Используемая терапия позволила уменьшить воспалительный процесс в орбите в короткие сроки, а последующая схема введения препарата закрепила полученный эффект и создала длительную ремиссию. Для лечения пациентов с ЭОП с целью обеспечения терапевтического эффекта необходимо использовать максимально безопасные дозы глюкокортикоидов. Определение назначаемой терапии должно проводиться с учетом степени тяжести и активности процесса.