Graves' disease ophtalmopathy medical therapy: Difference between revisions

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| style="padding: 5px 5px; background: #F5F5F5;" |Reduces autoreactive B cells
| 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;" |Very expensive; risk of infection, cancer, allergic reaction
| style="padding: 5px 5px; background: #F5F5F5;" |Two 1000-mg doses of intravenous rituximab 2 wk apart
| 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;" |Emergency orbital decompression

Revision as of 19:17, 5 April 2017

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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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