Evaluation of the patients with Grave’s ophthalmopathy after the corticosteroids treatment

Abstract

Background/Aim. Graves? ophthalmopthy is one of the most common causes of exophthalmos as well as the most common manifestation of Graves? disease. The treatment of Graves? ophthalmopathy includes ophthalmological and endocrinological therapy. The aim of this study was to clinically evaluate the patients with Graves? ophthalmopathy treated with corticosteroids. Methods. Evaluation of 21 patients was performed in the Ophthalmology Clinic and Endocrinology Clinic, Clinical Centre Kragujevac, in the period from 2009 to 2010. They were treated with pulse doses of intravenous corticosteroids. They were referred to ophthalmologist by endocrinologist in euthyroid condition in the active phase of Graves? ophthalmopathy (ultrasonography of orbit findings and positive findings of antithyroid stimulating hormone receptor antibody - anti-TSH R Ab). The clinical activity score (CAS) and NO SPECS classification for evaluation of disease severity were used. Ophthalmological examination includes: best corrected visual acuity, slit-lamp exam, Hertels? test, direct ophthalmoscopy and ultrasonography of the orbit. Results. According to our results 76.19% of the patients were female; mean age of the patients was 35.2 ? 5.6 years. According to CAS classification after 6 months of the treatment recovery was shown in 23.81% of the patients, partial amelioration in 47.62% and no clinical amelioration in 28.57% of the patients. We achieved better results with male, young patients with high clinical activity score. Good results were observed after the first dose of corticosteroids, much better CAS after the third dose, which maintained until 6 months after the first treatment. Conclusion. Our results signify that intravenous pulse dose of corticosteroids treatment of the patients with Graves? ophthalmopthy is safe, comfortable, clinically justified and accessible for the clinicians and patients. Positive results are achieved after the first dose with increasing trend up to the third dose, which was maintained for the next three months.Uvod/Cilj. Grejvsova oftalmopatija najcesci je uzrok egzoftalmusa i najcesca ekstratireoidna manifestacija bolesti. Za lecenje aktivne faze bolesti koriste se kortikosteroidi. Cilj rada bio je evaluacija lecenja bolesnika sa Grejvsovom oftalmopatijom tretiranih kortikosteroidnom terapijom. Metode. Ispitivan je 21 bolesnik u aktivnoj fazi bolesti, koji su u eutireoidnom statusu tretirani pulsnim dozama intravenskih (iv) kortikosteroida u Klinici za oftalmologiju i Klinici za endokrinologiju Klinickog Centra Kragujevac, od 01. 01. 2009. do 31. 12. 2010. Aktivnost Grejvsove oftalmopatije potvrdjena je ultrazvucnim pregledom orbite (oftalmolog) i odredjivanjem koncentracije antitela na receptore tireostimulisuceg hormona (TSH) ab (endokrinolog). Procena aktivnosti bolesti odredjivana je skorom klinicke aktivnosti (Clinical Activity Score - CAS), a stepen tezine bolesti NO SPECS klasifikacijom koja odredjuje klinicke aspekte ispitivanja i pracenja oftalmopatije. Klinicki pregled oftalmologa obuhvatao je: odredjivanje vidne ostrine, biomikroskopski pregled, direktnu oftalmoskopiju, egzoftalmometriju i ultrazvucni pregled orbite. Rezultati. Medju ispitanicima bilo je 76,19% pripadnika zenskog pola. Prosecna starost bolesnika bila je 35,2 ? 5,6 godina. Analiza podataka prema CAS klasifikaciji, posle sest meseci pokazala je: potpuni oporavak kod 23,81% bolesnika, a kod 47,62% parcijalni oporavak, dok kod 28,57% bolesnika nije bilo klinickog poboljsanja. Bolji terapijski rezultati postignuti su kod pripadnika muskog pola, mladjih, sa vecom klinickom aktivnoscu bolesti. Prvi pozitivni rezultati postizu se nakon prve doze kortikosteroida, bolji posle trece doze, a odrzavaju se na nivou, sest meseci posle prve doze lecenja. Zakljucak. Nasi rezultati ukazuju na visoku efikasnost lecenja bolesnika sa Grejvsovom oftalmopatijom primenom iv pulsnih doza kortikosteroida. Ovakav tretman je bezbedan i komforan i za lekara i za bolesnika. Pozitivni rezutlati vidljivi su vec posle prve doze kortikosteroida uz tendenciju poboljsanja posle trece doze, sto se odrzava tokom sledeca tri meseca.