Effect of Combined Intravenous Glucocorticoids and Orbital Radiotherapy in Restoring Driving Competency in Patients with Graves’ Orbitopathy

Abstract

Intravenous glucocorticoids and orbital radiotherapy are effective treatments for moderate-to-severe and active Graves' orbitopathy. We examined the ophthalmological outcome in daily life activities, such as driving competency. In a retrospective case series, 23 patients with moderate-to-severe and active Graves' disease (14 women and 7 men) were consecutively treated with combined orbital radiotherapy (13 Gy) and intravenous methylprednisolone (500 mg weekly for 6 consecutive weeks and 250 mg weekly for consecutive 6 weeks). The pretreatment Clinical Activity Score of 5.2 points (SD+/-0.9) decreased significantly to 2.7 points (SD+/-1.1) in the 12-month follow-up. Inflammatory eye signs, for example, pain and pressure sensation, caruncle inflammation, eyelid swelling, and exophthalmos decreased significantly. 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 stabismologic therapy including strabismus surgery was required. The combined therapy of intravenous glucocorticoids and orbital radiotherapy reduced inflammatory ophthalmological signs. In most cases strabismologic intervention including eye muscle surgery was necessary to restore driving competency.

Safety and Efficacy of Combined Immunosuppression and Orbital Radiotherapy in Thyroid-Related Restrictive Myopathy: Two-Center Experience

“…Although alterations in ocular motility were our primary concern, CAS as well as SIR was also assessed in all patients pretreatment and posttreatment and this may represent the first attempt in the literature to apply a modern assessment consensus in combined treatment regimens for TED. Overall improvement in CAS was found to be statistically significant and positively comparable to recent studies that involve pulse steroid treatment alone (17). Improvement in TED-related myopathy correlates to low CAS scores after treatment in this series of patients.…”

“…Other therapeutic options such as orbital radiotherapy and second-line immunosuppressants (12, 13) such as azathioprine (AZA) and cyclosporine, nonsteroidal anti-inflammatory drugs, and, more recently, biological agents (14, 15) have been proposed with success rates that vary according to different studies. Combined regimens have often been tried aiming to achieve better efficacy while reducing steroid-related adverse effects (16, 17). We have routinely used combined treatment protocols for 10 consecutive years in patients with severe, active, noncompressive TED using the onset of motility restriction as indication for treatment.…”

Combination Therapy of Intravenous Steroids and Orbital Irradiation is More Effective Than Intravenous Steroids Alone in Patients with Graves’ Orbitopathy

“…This probably means that side differences often persist despite motility improvements. Our rate is lower in comparison to trials of and Sterker et al (2009), who reported disappearance of diplopia in primary position in more than half of the patients due to iv GCs alone [23,45]. In the study of Kahaly et al the patients were treated even earlier (mean duration of GO 3-4 months) than the patients in our study.…”

Aktuelle Therapieansätze der endokrinen Orbitopathie – sind die zielgerichteten Therapien die Zukunft?

“…All 3 doses were effective; treatment with one Gy per week for 20 weeks was tolerated better [113]. A lower dose appears to be less effective in terms of improving ocular motility, but the soft tissue findings still improved [111,114]. Two large retrospective studies further investigated the extent to which radiotherapy influenced the development of compressive optic neuropathy.…”

“…Alle 3 Dosierungen waren wirksam, die Therapie mit 1 Gy pro Woche über 20 Wochen erwies sich als besser verträglich 113 . Eine niedrigere Dosierung scheint hinsichtlich der Motilitätsverbesserung weniger wirksam, es bessern sich aber immer noch die Weichteilbefunde 111 , 114 . In 2 großen retrospektiven Studien wurde weiterhin untersucht, inwieweit eine Strahlentherapie die Entwicklung einer kompressiven Optikusneuropathie beeinflusst.…”