Surgical treatment of Graves’ ophthalmopathy

Eckstein, Anja; Schittkowski, Michael; Esser, Joachim

doi:10.1016/j.beem.2011.11.002

Cited by 72 publications

(73 citation statements)

References 71 publications

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“…In order to achieve this goal, multiple operations may be necessary. However, the persistence of diplopia in extreme upgaze is common, but it is usually well tolerated with a negligible effect on overall visual function (133). Eyelid surgery is generally the last step of rehabilitation, and its aim is the correction of residual eyelid malpositions after medical treatment or orbital decompression (133).…”

Section: Outcome Of Treatment and Patient's Satisfactionmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Campi

Vannucchi

Salvi

2016

European Journal of Endocrinology

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Management of Graves' orbitopathy (GO) must be based on the correct assessment of activity and severity of the disease. Activity is usually assessed with the Clinical Activity Score, whereas severity is classified according to a European Group On Graves' Orbitopathy (EUGOGO) consensus statement as mild, moderate-to-severe, and sight-threatening. Myopathic and chronic congestive forms are uncommon clinical presentations of GO. Restoration and maintenance of stable euthyroidism are recommended in the presence of GO. In moderate-to-severe disease, steroids have been widely employed and have shown to possess an anti-inflammatory activity, but about 20 -30% of patients are not responsive and present recurrence. Some novel immunosuppressors have already been employed in clinical studies and have shown interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the thyroid-stimulating hormone and the insulin-like growth factor 1 receptor on the fibroblasts, inflammatory cytokines, B and T cells, and the PIK3/mTORC1 signaling cascades for adipogenesis. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials. As the main goal of treatment is the well-being of the patient, the therapeutic strategy should be addressed to better suit the patient needs, more than improving one or more biological parameters. The increasing availability of new therapies will expand the therapeutic options for GO patients and allow the clinician to really personalize the treatment to better suit the patients' personal needs.

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Section: Outcome Of Treatment and Patient's Satisfactionmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Campi

Vannucchi

Salvi

2016

European Journal of Endocrinology

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“…Surgical procedures may be multiple in some patients, including orbital decompression for exophthalmos (usually poorly responsive to medical treatment), squint surgery for extraocular muscle dysfunction and related diplopia, and eyelid surgery for persisting palpebral malposition. Surgery should be avoided when GO is active (with the exception of urgent orbital decompression in unresponsive dysthyroid optic neuropathy or corneal breakdown); if multiple surgical procedures are needed, orbital decompression should come first, followed by squint surgery and, lastly, by eyelid surgery [80]. A period of 6 months should elapse between one procedure and the following one [80].…”

Section: Managementmentioning

confidence: 99%

“…Surgery should be avoided when GO is active (with the exception of urgent orbital decompression in unresponsive dysthyroid optic neuropathy or corneal breakdown); if multiple surgical procedures are needed, orbital decompression should come first, followed by squint surgery and, lastly, by eyelid surgery [80]. A period of 6 months should elapse between one procedure and the following one [80]. …”

Section: Managementmentioning

confidence: 99%

Graves' Orbitopathy: Imperfect Treatments for a Rare Disease

Bartalena

2013

Eur Thyroid J

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Graves' orbitopathy (GO) is the most frequent and invalidating extrathyroidal expression of Graves' disease. Its incidence and prevalence are, however, low. About three quarters of Graves' patients have no GO at diagnosis, and moderate-to-severe and severe forms represent no more that 5-6% of cases. Progression to severe forms occurs rarely, but it may be caused by risk factors, the most important being smoking and poor control of thyroid dysfunction. Lot of progress has been recently achieved in the understanding of GO pathogenesis, while the disease remains a therapeutic challenge and dilemma. Common treatments for moderate-to-severe and active forms of GO (glucocorticoids and orbital radiotherapy) frequently provide incomplete responses and may be followed by relapse or progression of GO. After the disease has been inactivated by medical treatment, many patients need rehabilitative surgery for residual manifestations (orbital decompression for exophthalmos, squint surgery for extraocular muscle dysfunction, eyelid surgery for eyelid malposition). Novel pharmacological treatments are on the horizon and might target pathogenetic mechanisms of the disease better than glucocorticoids. Clinical evidence concerning their efficacy and safety is presently lacking.

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“…Many authors recommend decompression of the medial wall as the best approach for patients with DON [8,9,19]. However, other surgical approaches are also presented: two-wall medial-lateral and three-wall medial-lateral-inferior orbital decompression combined with fat removal [20].…”

Section: Discussionmentioning

confidence: 99%

“…The European Group on Graves' Orbitopathy (EUGOGO) recommends intravenous glycocorticosteroid pulse therapy (ivGCS) and urgent decompression if there is no response for two weeks [6,7]. Decompression of the medial orbital wall is the optimal surgical strategy [8]. However, there are no recommendations on how aggressive further therapy should be in cases where a complete recovery is not achieved.…”

Section: Introductionmentioning

confidence: 99%

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

Miśkiewicz

Rutkowska

Jabłońska

et al. 2016

Endokrynologia Polska

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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)

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Surgical treatment of Graves’ ophthalmopathy

Cited by 72 publications

References 71 publications

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Graves' Orbitopathy: Imperfect Treatments for a Rare Disease

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

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