Pelewicz Maryla, Rymuza Joanna, Pelewicz Katarzyna, Miśkiewicz Piotr
Department of Internal Medicine and Endocrinology, Medical University of Warsaw, 02-091 Warsaw, Poland.
J Clin Med. 2022 Apr 7;11(8):2068. doi: 10.3390/jcm11082068.
Background: Dysthyroid optic neuropathy (DON) is a sight-threatening complication of Graves’ orbitopathy (GO). Treatment of DON consists of the urgent administration of intravenous methylprednisolone (ivMP) in very high doses followed by orbital decompression if the response is poor or absent. It is advised to continue the therapy with pulses of ivMP in a weekly schedule. The purpose of this study was to evaluate the impact of the additional treatment with ivMP in a 12-week protocol on visual acuity (VA), color vision, clinical activity score (CAS) and proptosis in patients with DON. Methods: This study was performed on 19 patients with DON (26 eyes) treated with ivMP in very high doses, with further orbital decompression in 11 individuals (15 eyes). VA, color vision, CAS and proptosis were evaluated prior to the DON treatment, before and after the 12-week ivMP (first and last pulse). Additionally follow up was performed (22 eyes). Results: VA and color vision improved between the first and last pulse of the additional ivMP treatment (p = 0.04 and p = 0.003, respectively). CAS and proptosis were reduced at the end of the 12-week ivMP therapy compared to observations at the beginning (p < 0.001 and p = 0.04, respectively). Follow up confirmed stabilization of this achievement. Conclusions: The results of this study suggest that additional treatment with 12 pulses of ivMP improves or stabilizes the outcome of basic therapy in patients with DON.
甲状腺功能异常性视神经病变（DON）是格雷夫斯眼眶病（GO）的一种威胁视力的并发症。DON的治疗包括紧急静脉注射大剂量甲泼尼龙（ivMP），如果反应不佳或无反应则随后进行眼眶减压。建议按每周一次的方案继续使用ivMP脉冲进行治疗。本研究的目的是评估在12周方案中额外使用ivMP治疗对DON患者的视力（VA）、色觉、临床活动评分（CAS）和眼球突出度的影响。方法：本研究对19例接受大剂量ivMP治疗的DON患者（26只眼）进行，其中11例（15只眼）进一步接受了眼眶减压。在DON治疗前、12周ivMP治疗前后（第一次和最后一次脉冲）评估VA、色觉、CAS和眼球突出度。此外还进行了随访（22只眼）。结果：在额外的ivMP治疗的第一次和最后一次脉冲之间，VA和色觉有所改善（分别为p = 0.04和p = 0.003）。与开始时的观察结果相比，12周ivMP治疗结束时CAS和眼球突出度降低（分别为p < 0.001和p = 0.04）。随访证实了这一结果的稳定性。结论：本研究结果表明，额外进行12次ivMP脉冲治疗可改善或稳定DON患者基础治疗的效果。
