Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland.
Klin Monbl Augenheilkd. 2021 Jan;238(1):24-32. doi: 10.1055/a-1328-2884. Epub 2021 Jan 27.
The therapy of severe manifestations of Graves' orbitopathy (GO) is still a challenge and requires good interdisciplinary cooperation. It is especially important to use stage-adapted anti-inflammatory therapy to avoid irreversible damage.
Discussion of the latest results of multicentre randomised therapy studies on anti-inflammatory treatments for Graves' orbitopathy, as well as new therapeutic concepts.
Mild cases of GO can be treated with only selenium supplementation and a watchful waiting strategy. In the moderate-to-severe active form of GO, primary therapy consists of i. v. steroids (cumulative 4 - 5 g) in combination with orbital irradiation in patients with impaired motility. In patients with insufficient therapeutic response after 6 weeks, treatment should be switched to other immunosuppressive agents. In severe sight-threatening disease, bony orbital decompression is usually necessary. As basic research has improved our understanding of the underlying pathophysiology of GO, it has been possible to develop targeted therapies for GO. Teprotumumab, an IGF-1 receptor antibody, was effective in treating GO patients in a phase III trial and should soon be awarded approval for Europe.
The current therapy concept for Graves' orbitopathy is as follows: first anti-inflammatory therapy then surgical correction of the permanent defects. This may soon be modified, due to the use of targeted therapies.
Graves 眼病（GO）严重表现的治疗仍然是一个挑战，需要良好的跨学科合作。使用阶段适应的抗炎治疗以避免不可逆转的损害尤为重要。
讨论多中心随机治疗研究中 Graves 眼病抗炎治疗的最新结果以及新的治疗概念。
轻度 GO 可仅用硒补充剂和观察等待策略治疗。在中度至重度活动性 GO 中，原发性治疗包括静脉内类固醇（累积 4-5g）联合运动障碍患者的眼眶照射。在 6 周后治疗反应不足的患者中，应将治疗转换为其他免疫抑制剂。在严重威胁视力的疾病中，通常需要进行骨性眼眶减压。随着基础研究提高了我们对 GO 潜在病理生理学的理解，已经有可能为 GO 开发靶向治疗。在 III 期试验中，IGF-1 受体抗体 teprotumumab 对 GO 患者有效，很快将在欧洲获得批准。
Graves 眼病的当前治疗概念如下：首先进行抗炎治疗，然后再纠正永久性缺陷。由于靶向治疗的使用，这种情况可能很快会发生改变。
