Graves' disease ophtalmopathy medical therapy: Difference between revisions

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==Overview==
==Overview==
Treatment of ophthalmopathy depends on the phase and severity of the disease. It ranges from enhancement of tear-film quality and maintenance of ocular surface moisture for mild disease to intravenously administered pulse glucocorticoid therapy for severe and sight threatening disease.


==Ophtalmopathy==
==Ophtalmopathy==
*Treatment for ophthalmopathy depends on the phase and severity of the disease.
*Treatment for ophthalmopathy depends on the phase and severity of the disease.
*It is ranged from enhancement of tear-film quality and maintenance of ocular surface moisture for mild disease to intravenously administered pulse glucocorticoid therapy for severe and sight threatening disease.
*It ranges from enhancement of tear-film quality and maintenance of ocular surface moisture for mild disease to intravenously administered pulse glucocorticoid therapy for severe and sight threatening disease.




The table below summarizes the treatment options for ophtalmopathy.
The table below summarizes the treatment options for ophtalmopathy.<ref name="pmid21864187">{{cite journal |vauthors=Weissel M |title=Selenium and the course of mild Graves' orbitopathy |journal=N. Engl. J. Med. |volume=365 |issue=8 |pages=769–70; author reply 770–1 |year=2011 |pmid=21864187 |doi=10.1056/NEJMc1107080#SA1 |url=}}</ref><ref name="pmid21239515">{{cite journal |vauthors=Zang S, Ponto KA, Kahaly GJ |title=Clinical review: Intravenous glucocorticoids for Graves' orbitopathy: efficacy and morbidity |journal=J. Clin. Endocrinol. Metab. |volume=96 |issue=2 |pages=320–32 |year=2011 |pmid=21239515 |doi=10.1210/jc.2010-1962 |url=}}</ref><ref name="pmid23038682">{{cite journal |vauthors=Bartalena L, Krassas GE, Wiersinga W, Marcocci C, Salvi M, Daumerie C, Bournaud C, Stahl M, Sassi L, Veronesi G, Azzolini C, Boboridis KG, Mourits MP, Soeters MR, Baldeschi L, Nardi M, Currò N, Boschi A, Bernard M, von Arx G |title=Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=12 |pages=4454–63 |year=2012 |pmid=23038682 |doi=10.1210/jc.2012-2389 |url=}}</ref><ref name="pmid16889639">{{cite journal |vauthors=Aktaran S, Akarsu E, Erbağci I, Araz M, Okumuş S, Kartal M |title=Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves' ophthalmopathy |journal=Int. J. Clin. Pract. |volume=61 |issue=1 |pages=45–51 |year=2007 |pmid=16889639 |doi=10.1111/j.1742-1241.2006.01004.x |url=}}</ref><ref name="pmid18550875">{{cite journal |vauthors=Brent GA |title=Clinical practice. Graves' disease |journal=N. Engl. J. Med. |volume=358 |issue=24 |pages=2594–605 |year=2008 |pmid=18550875 |doi=10.1056/NEJMcp0801880 |url=}}</ref>
 
 
{| style="border: 0px; font-size: 75%; margin: 3px;" align=center
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Severity}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Therapy}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Mechanism}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Advantages/disadvantages}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1  | {{fontcolor|#FFFFFF|Common Doses}}
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=1 colspan=1 |{{fontcolor|#FFFFFF|Mild active disease}}
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 | Topical solutions <br>Artificial tears<br>Glucocorticoids<br>Avoidance of wind, light, dust, smoke<br>Elevation of head during sleep<br>Avoidance of eye cosmetics<br>Selenium
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 | <br>Maintain tear film<br>Reduce inflammation<br>Reduces ocular surface desiccation, reduces irritation<br>Reduces orbital congestion<br>Reduces irritation<br>Uncertain
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 | Rapid action, minimal side effects<br>Rapid action, minimal side effects<br> <br>Benefits not yet confirmed<br>Benefits not yet confirmed<br>
| style="background: #F5F5F5; padding: 5px 5px;" rowspan=1 colspan=1 |
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Moderate or severe active disease}}
| style="padding: 5px 5px; background: #F5F5F5;" |Systemic glucocorticoids <br>Oral<br>Intravenous
| style="padding: 5px 5px; background: #F5F5F5;" |<br>Reduces inflammation and orbital congestion
| style="padding: 5px 5px; background: #F5F5F5;" |<br>Hyperglycemia, hypertension, osteoporosis<br>Rapid onset of anti-inflammatory effect, fewer side, liver damage
| style="padding: 5px 5px; background: #F5F5F5;" |<br>Up to 100 mg of oral prednisone daily, followed by tapering of the dose<br>Methylprednisolone, 500 mg/wk for 6 wk followed by 250 mg/wk for 6 wk
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Orbital irradiation
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces inflammation
| style="padding: 5px 5px; background: #F5F5F5;" |Can induce retinopathy
| style="padding: 5px 5px; background: #F5F5F5;" |2 Gy daily for 2 wk (20 Gy total)
|-
| style="padding: 5px 5px; background: #F5F5F5;" |B-cell depletion
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces autoreactive B cells
| style="padding: 5px 5px; background: #F5F5F5;" |Very expensive; risk of infection, cancer, allergic reaction
| style="padding: 5px 5px; background: #F5F5F5;" |Two 1000-mg doses of intravenous rituximab 2 wks apart
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Emergency orbital decompression
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces orbital volume
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="background: #4479BA; padding: 5px 5px;" rowspan=4 colspan=1 |{{fontcolor|#FFFFFF|Stable disease (inactive)}}
| style="padding: 5px 5px; background: #F5F5F5;" |Orbital decompression (fat removal)
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces orbital volume
| style="padding: 5px 5px; background: #F5F5F5;" |Postoperative diplopia, pain
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Bony decompression of the lateral and medial walls
| style="padding: 5px 5px; background: #F5F5F5;" |Reduces proptosis by enlarging orbital space
| style="padding: 5px 5px; background: #F5F5F5;" |Postoperative diplopia, pain, sinus bleeding, cerebrospinal fluid leak
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Strabismus repair
| style="padding: 5px 5px; background: #F5F5F5;" |Improves eye alignment, reduces diplopia
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Eyelid repair
| style="padding: 5px 5px; background: #F5F5F5;" |Improves appearance, reduces lagophthalmos and improves function
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|}
 




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{{reflist|2}}
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[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Primary care]]
[[Category:Medicine]]
[[Category:Medicine]]
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{{WS}}

Latest revision as of 21:56, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Treatment of ophthalmopathy depends on the phase and severity of the disease. It ranges from enhancement of tear-film quality and maintenance of ocular surface moisture for mild disease to intravenously administered pulse glucocorticoid therapy for severe and sight threatening disease.

Ophtalmopathy

  • Treatment for ophthalmopathy depends on the phase and severity of the disease.
  • It ranges from enhancement of tear-film quality and maintenance of ocular surface moisture for mild disease to intravenously administered pulse glucocorticoid therapy for severe and sight threatening disease.


The table below summarizes the treatment options for ophtalmopathy.[1][2][3][4][5]


Severity Therapy Mechanism Advantages/disadvantages Common Doses
Mild active disease Topical solutions
Artificial tears
Glucocorticoids
Avoidance of wind, light, dust, smoke
Elevation of head during sleep
Avoidance of eye cosmetics
Selenium
Maintain tear film
Reduce inflammation
Reduces ocular surface desiccation, reduces irritation
Reduces orbital congestion
Reduces irritation
Uncertain 		Rapid action, minimal side effects
Rapid action, minimal side effects

Benefits not yet confirmed
Benefits not yet confirmed
Moderate or severe active disease Systemic glucocorticoids
Oral
Intravenous
Reduces inflammation and orbital congestion
Hyperglycemia, hypertension, osteoporosis
Rapid onset of anti-inflammatory effect, fewer side, liver damage
Up to 100 mg of oral prednisone daily, followed by tapering of the dose
Methylprednisolone, 500 mg/wk for 6 wk followed by 250 mg/wk for 6 wk
Orbital irradiation Reduces inflammation Can induce retinopathy 2 Gy daily for 2 wk (20 Gy total)
B-cell depletion Reduces autoreactive B cells Very expensive; risk of infection, cancer, allergic reaction Two 1000-mg doses of intravenous rituximab 2 wks apart
Emergency orbital decompression Reduces orbital volume
Stable disease (inactive) Orbital decompression (fat removal) Reduces orbital volume Postoperative diplopia, pain
Bony decompression of the lateral and medial walls Reduces proptosis by enlarging orbital space Postoperative diplopia, pain, sinus bleeding, cerebrospinal fluid leak
Strabismus repair Improves eye alignment, reduces diplopia
Eyelid repair Improves appearance, reduces lagophthalmos and improves function





References

  1. ↑ Weissel M (2011). "Selenium and the course of mild Graves' orbitopathy". N. Engl. J. Med. 365 (8): 769–70, author reply 770–1. doi:10.1056/NEJMc1107080#SA1. PMID 21864187.
  2. ↑ Zang S, Ponto KA, Kahaly GJ (2011). "Clinical review: Intravenous glucocorticoids for Graves' orbitopathy: efficacy and morbidity". J. Clin. Endocrinol. Metab. 96 (2): 320–32. doi:10.1210/jc.2010-1962. PMID 21239515.
  3. ↑ Bartalena L, Krassas GE, Wiersinga W, Marcocci C, Salvi M, Daumerie C, Bournaud C, Stahl M, Sassi L, Veronesi G, Azzolini C, Boboridis KG, Mourits MP, Soeters MR, Baldeschi L, Nardi M, Currò N, Boschi A, Bernard M, von Arx G (2012). "Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy". J. Clin. Endocrinol. Metab. 97 (12): 4454–63. doi:10.1210/jc.2012-2389. PMID 23038682.
  4. ↑ Aktaran S, Akarsu E, Erbağci I, Araz M, Okumuş S, Kartal M (2007). "Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves' ophthalmopathy". Int. J. Clin. Pract. 61 (1): 45–51. doi:10.1111/j.1742-1241.2006.01004.x. PMID 16889639.
  5. ↑ Brent GA (2008). "Clinical practice. Graves' disease". N. Engl. J. Med. 358 (24): 2594–605. doi:10.1056/NEJMcp0801880. PMID 18550875.

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