Powrót pełnej ostrości wzroku jako główny cel leczenia pacjentów z neuropatią nerwu wzrokowego w przebiegu orbitopatii Gravesa

Abstract

Introduction: To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy. Material and methods: The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA < 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment -intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment -endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment -additional MP therapy and/or surgical decompression. Results: A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves' orbitopathy clinical activity score (p = 0.035). Conclusions: By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON. (Endokrynol Pol 2016; 67 (2): 166-173)

Clinical and immunological changes in patients with active moderate-to-severe Graves̕ orbitopathy treated with very low-dose rituximab

“…They both were glucocorticoid-resistant, and rituximab represented the second-line therapeutic option. Surgical decompression led to a complete recovery [22]. Rituximab was successfully used in patients with DON [19,23,24], but available evidence from one of the randomised studies [16], as well as a case report of a patient with glucocorticoid-resistant GO [25], suggests that progression of DON may occur after rituximab, even after its higher doses.…”

Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management

“…For every decade increase in age of onset of TED, the odds of developing DON may increase by 58%[11]. Age may also affect the response to DON treatment with younger age predicting a better outcome (p=0.049)[19]. Male gender also shows a strong correlation with the development of DON, especially with advancing age[1,4,5,17].…”

“…Fortunately, regimens consisting of iv-MP, ORT, and surgical decompression effectively improve visual outcome in the vast majority of cases with complete visual recovery in approximately 70% of cases [14,19]. Positive predictive factors include younger age, shorter duration of neuropathy, and higher initial CAS, likely indicating earlier disease course[19]. Though quality of life (QoL) comprises an essential aspect of treatment outcome, it is far less commonly assessed and studied than clinical measures, especially for DON.…”

Prevalence of Radiological Signs of Dysthyroid Optic Neuropathy in Magnetic Resonance Imaging in Patients with Active, Moderate-to-Severe, and Very Severe Graves Orbitopathy

“…Five patients with DON had unilateral optic nerve involvement. Patients were treated with high doses of intravenous methylprednisolone pulses (ivMP) as first-line therapy (1 g/day for 3 consecutive days) and with orbital decompression as second-line therapy in cases which lacked improvement [11, 12]. In some of the patients additional treatment was necessary (ivMP, other orbital decompression) [11].…”