PURPOSE: Graves' ophthalmopathy (GO) is a common cause of morbidity in patients with Graves disease which suboptimal management is widespread. Immunosuppressive drugs and orbital irradiation represent treatment options for patients with moderate to severe and active GO. The aim of this study is to share our initial results from the application of orbital radiotherapy in GO.
MATERIAL AND METHODS: Fifteen consecutive patients (12 women and 3 men) at a mean age 52 years (range, 26 to 62 years) with GO underwent radiotherapy of posterior orbit. Research team included a radiotherapist, endocrinologist and ophthalmologist performing the first and the follow-up examinations. Both orbits were examined for soft tissue and cornea involvement, proptosis, eye muscle impairment, visual acuity, visual fields and tonometry. Ophthalmic index was calculated before and after treatment. All the patients had received glucocorticoids before radiotherapy as 46.67% of them required corticosteroids during the period of irradiation and 80% received antithyroid medication. Overall clinical response was evaluated as excellent, good, fair or no response according to Donaldson's criteria.
RESULTS: Fifteen patients completed the study with a follow-up of two or more months. All of them received 20 Gy to both orbits. The overall clinical response was excellent in two patients (13.33%), good in seven (46.67%), fair in five (33.33%), and there was no response in one patient (6.67% of the cases). The mean ophthalmopathy index (OI) was 7.2 before treatment and 3 after irradiation. There was a mean OI improvement of 4.2 points (range 2-7) compared to the pretreatment values. Best response was achieved for corneal involvement, soft tissue symptoms, sight loss and eye muscle impairment, while the response for proptosis was limited. No late adverse effects associated with radiotherapy such as cataract and radiation-induced retinopathy were observed at all.
CONCLUSION: Our study proved that orbital radiotherapy is an effective and safe treatment option for progressive GO with better results in the early and acute stage of the disease.
Scripta Scientifica Medica 2013; 45(4): 41-45.
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