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Early response to intravenous glucocorticoids for severe thyroid-associated ophthalmopathy predicts treatment outcome

Lookup NU author(s): Professor Pat Kendall-Taylor, Dr Petros Perros

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Abstract

Background/Aims: The results for 18 consecutive patients with severe thyroid-associated ophthalmopathy (TAO) treated with high-dose, pulsed intravenous methylprednisolone (MP) are presented in this paper. Methods: Eighteen (18) patients with severe TAO, defined as either optic neuropathy, progressive diplopia, or severe soft-tissue swelling accompanied by evidence of NOSPECS class 2b or more severe eye disease, were studied in a prospective, noncontrolled case series. Patients were treated with 1.5 g of intravenous MP, divided over 3 days, followed by a tapering course of oral prednisolone. All patients were examined before treatment, 1 week and 1 month after commencement of treatment and at 2-3 monthly intervals thereafter. Assessment of visual acuity, differential intraocular pressure (IOP), soft-tissue inflammation, diplopia, and exophthalmometry were used to calculate a modified ophthalmopathy index (OI) for each patient at each visit. Median duration of follow-up was 14 months. Results: A statistically significant reduction in OI following treatment with high-dose MP was observed after 1 week of treatment from 10.8 ± 3.9 standard deviation (SD) to 8.3 ± 3.4 (SD) (P < 0.001) and between 1 week and the end of the treatment period (OI, 7.2 ± 3.4 (SD); P < 0.05). A response occurred in 83% of patients within a week but only 66% maintained this response. There was a significant negative correlation between response to treatment (OI before treatment-OI after treatment) and duration of eye disease (P = 0.034, Spearman correlation). Conclusions: High-dose, pulsed intravenous MP is an effective medical treatment for severe TAO. Responders can be identified within the 1st week. Treatment response is inversely related to disease duration. © Mary Ann Liebert, Inc.


Publication metadata

Author(s): Hart RH, Kendall-Taylor P, Crombie A, Perros P

Publication type: Article

Publication status: Published

Journal: Journal of Ocular Pharmacology and Therapeutics

Year: 2005

Volume: 21

Issue: 4

Pages: 328-336

ISSN (print): 1080-7683

ISSN (electronic): 1557-7732

Publisher: Mary Ann Liebert, Inc. Publishers

URL: http://dx.doi.org/10.1089/jop.2005.21.328

DOI: 10.1089/jop.2005.21.328

PubMed id: 16117697


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