Sobel Rachel K, Aakalu Vinay K, Vagefi M Reza, Foster Jill A, Tao Jeremiah P, Freitag Suzanne K, Wladis Edward J, McCulley Timothy J, Yen Michael T
Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee.
Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois.
Ophthalmology. 2022 Apr;129(4):450-455. doi: 10.1016/j.ophtha.2021.10.025. Epub 2021 Dec 9.
To review the current literature on the safety and efficacy of orbital radiation for the management of thyroid eye disease (TED).
A literature search was conducted last in February 2021 of the PubMed database to identify all articles published in the English language on original research that assessed the effect of orbital radiation on TED. The search identified 55 articles, and 18 met the inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study, and all of them were rated level III.
Two large retrospective studies demonstrated the efficacy of radiation treatment, with or without corticosteroid use, in preventing or treating compressive optic neuropathy (CON). Three studies highlighted the role of orbital radiation therapy (RT) to facilitate the tapering of corticosteroids. Several other studies showed a possible role for RT to improve diplopia and soft tissue signs.
Although no level I or level II evidence exists, the best available evidence suggests that orbital radiation, used with or without corticosteroids, is efficacious in preventing CON, improving motility restriction, and decreasing clinical activity in TED. Orbital radiation also may facilitate a corticosteroid taper. Together, these studies show that RT seems to modify the active phase of TED. Short-term risks of orbital radiation are minor, but long-term outcome data are lacking.
回顾目前关于眼眶放射治疗甲状腺眼病（TED）的安全性和有效性的文献。
最近于2021年2月对PubMed数据库进行文献检索，以识别所有用英文发表的关于评估眼眶放射对TED影响的原始研究文章。检索到55篇文章，其中18篇符合本评估的纳入标准。然后，一名专业方法学家为每项研究指定证据等级，所有研究均被评为III级。
两项大型回顾性研究证明了放射治疗（无论是否使用皮质类固醇）在预防或治疗压迫性视神经病变（CON）方面的有效性。三项研究强调了眼眶放射治疗（RT）在促进皮质类固醇减量方面的作用。其他几项研究表明RT在改善复视和软组织体征方面可能发挥作用。
虽然不存在I级或II级证据，但现有最佳证据表明，无论是否使用皮质类固醇，眼眶放射在预防CON、改善运动受限和降低TED的临床活动度方面是有效的。眼眶放射也可能有助于皮质类固醇的减量。这些研究共同表明，RT似乎可以改变TED的活动期。眼眶放射的短期风险较小，但缺乏长期结局数据。
