Grassi P, Strianese D, Piscopo R, Pacelli R, Bonavolontà G
Department of Neuroscience, Odontostomatological and Reproductive Sciences, University "Federico II" of Naples, via Pansini no 5, 80131, Naples, Italy.
Department of Ophthalmology, Humanitas Research Hospital, Rozzano, Milan, Italy.
Ir J Med Sci. 2017 Aug;186(3):647-652. doi: 10.1007/s11845-016-1542-3. Epub 2017 Jan 3.
To evaluate the efficacy of orbital radiotherapy (OR) for the treatment of thyroid eye disease (TED).
Thirty-five consecutive patients with active TED with contraindications to steroid therapy received a course of OR. Bilateral retrobulbar irradiation was performed with a total dose of 20 Gy. 7-points clinical activity score (7-CAS), ocular motility, visual acuity (VA), exophthalmos and eyelid retraction were prospectively evaluated at 3, 6 and 12 months and compared with baseline data.
There was a statistically significant improvement in 7-CAS at 3, 6 and 12 months post-treatment (p < 0.05). Ocular motility disturbances improved at 6 and 12 months (p < 0.05). Visual acuity remained stable; there was no significant change in exophthalmos (mean 24 mm, SD 3 mm) or eyelid retraction (marginal reflex distance mean 6 mm, SD 1.5 mm) during the follow-up period. No side effects were registered.
This study suggests that OR might be effective in reducing 7-CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. OR might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids.
评估眼眶放射治疗（OR）对甲状腺眼病（TED）的治疗效果。
35例连续的活动性TED患者因类固醇治疗存在禁忌证而接受了一个疗程的OR。进行双侧球后照射，总剂量为20 Gy。在3、6和12个月时前瞻性评估7分临床活动评分（7-CAS）、眼球运动、视力（VA）、眼球突出度和眼睑退缩情况，并与基线数据进行比较。
治疗后3、6和12个月时7-CAS有统计学意义的改善（p < 0.05）。眼球运动障碍在6和12个月时得到改善（p < 0.05）。视力保持稳定；随访期间眼球突出度（平均24 mm，标准差3 mm）或眼睑退缩（边缘反射距离平均6 mm，标准差1.5 mm）无显著变化。未记录到副作用。
本研究表明，OR可能在降低7-CAS和眼球运动障碍方面有效。预计这种治疗对眼球突出或眼睑退缩无显著改善。对于不能耐受类固醇的TED患者，OR可被视为一种合适的替代治疗方法。
