Ponto K A, Pitz S, Mann W J, Weber M M, Pfeiffer N, Kahaly G J
Augenklinik, Orbitazentrum der Johannes Gutenberg Universitätsmedizin Mainz.
Dtsch Med Wochenschr. 2009 Dec;134(49):2521-4. doi: 10.1055/s-0029-1243057. Epub 2009 Nov 25.
Patients with Graves' orbitopathy (GO) suffer from disfiguring proptosis, orbital pain and diplopia. Compression of the optic nerve may cause functional restrictions to the point of loss of vision. Since suboptimal management of GO seems to be widespread, the European Group On Graves' Orbitopathy (EUGOGO) provided a consensus statement on the management of GO. According to EUGOGO, patients with GO should be referred to multidisciplinary specialist centers. All patients should be encouraged to quit smoking. Prompt treatment of thyroid dysfunction is mandatory in order to restore and maintain euthyroidism. The first-line treatment for optic neuropathy and/or corneal ulceration are intravenous glucocorticoids. If the response is poor after 1-2 weeks, orbital decompression surgery should follow. Intravenous glucocorticoids are also recommended in patients with moderate-to-severe and active GO. If GO is inactive, surgery should be considered. Local measures and an expectant strategy are sufficient in most patients with mild GO, but if quality of life is affected significantly, specific treatment may be justified. Thus, management of GO remains challenging and is best performed within a multidisciplinary orbital center.
格雷夫斯眼眶病（GO）患者会出现毁容性眼球突出、眼眶疼痛和复视。视神经受压可能导致功能受限，甚至失明。由于GO的管理欠佳似乎较为普遍，欧洲格雷夫斯眼眶病研究小组（EUGOGO）发布了一份关于GO管理的共识声明。根据EUGOGO的建议，GO患者应转诊至多学科专科中心。应鼓励所有患者戒烟。必须及时治疗甲状腺功能障碍，以恢复并维持甲状腺功能正常。视神经病变和/或角膜溃疡的一线治疗方法是静脉注射糖皮质激素。如果1-2周后反应不佳，则应进行眼眶减压手术。中度至重度活动性GO患者也建议使用静脉注射糖皮质激素。如果GO不活跃，则应考虑手术治疗。大多数轻度GO患者采取局部措施和观察策略就足够了，但如果生活质量受到显著影响，则进行特定治疗可能是合理的。因此，GO的管理仍然具有挑战性，最好在多学科眼眶中心进行。
