Nasr Elie, Khater Sherine, Nehme-Nasr Dolly, Azoury Fares, Jambart Selim
Service de Radiothérapie, CHU Hôtel-Dieu de France, Beyrouth, Liban.
J Med Liban. 2010 Apr-Jun;58(2):86-90.
Graves' ophthalmopathy is a debilitating disease impairing the quality of life of affected individuals. The management of moderate-to-severe active Graves' ophthalmopathy is a major therapeutic challenge, and the treatment outcome is often unsatisfactory. We have carried out a retrospective study to assess the efficacy of combined orbital irradiation and systemic corticosteroids. Ten patients were included; all patients had received 20 Grays to the retrobulbar tissues in ten fractions, and oral or intravenous glucocorticoids. The main therapeutic outcome measures were the criteria of Donaldson and co-workers and a self-assessment evaluation. The quality of life outcome was also evaluated by the GO-QOL (Graves' ophthalmopathy quality of life) questionnaire. Seven patients (70%) demonstrated improvement in ocular parameters; the response was excellent in three cases, good in three cases and fair in one case. Three patients showed no response to the treatment. The self-assessment evaluation showed that 75% of patients were satisfied with the results of the treatment. Proptosis was the most responsive sign to radiation and steroids. A duration of the eye disease of more than 18 months was associated with less improvement and a higher failure of the treatment. Concerning the quality of life, the score for visual fonctionning was 882 +/- 18.2 after treatment, while the score for appearance was 63.3 +/- 23.3. In conclusion, a combination of orbital irradiation and systemic steroids is associated with 70% of favorable responses, but the quality of life is not restored in the same proportions and remains impaired after treatment.
格雷夫斯眼病是一种使人衰弱的疾病，会损害患者的生活质量。中重度活动性格雷夫斯眼病的治疗是一项重大的治疗挑战，治疗效果往往不尽人意。我们进行了一项回顾性研究，以评估眼眶照射与全身使用皮质类固醇联合治疗的疗效。研究纳入了10名患者；所有患者均接受了10次分割、每次20格雷的球后组织照射，并使用了口服或静脉注射糖皮质激素。主要治疗结局指标采用唐纳森及其同事的标准以及自我评估。生活质量结局也通过格雷夫斯眼病生活质量（GO-QOL）问卷进行评估。7名患者（70%）的眼部参数有所改善；其中3例效果极佳，3例良好，1例一般。3名患者对治疗无反应。自我评估显示，75%的患者对治疗结果满意。眼球突出是对放疗和类固醇反应最明显的体征。眼病病程超过18个月与改善较少及治疗失败率较高相关。关于生活质量，治疗后视觉功能评分为882±18.2，外观评分为63.3±23.3。总之，眼眶照射与全身类固醇联合治疗有70%的有效反应，但生活质量并未按相同比例恢复，治疗后仍受到损害。
