Oeverhaus Michael, Stöhr Mareile, Möller Lars, Führer Dagmar, Eckstein Anja
Klinik für Augenheilkunde, Universitatsklinikum Essen, Essen, Germany.
Klinik für Endokrinologie, Universitatsklinikum Essen, Essen, Germany.
Laryngorhinootologie. 2023 Mar;102(3):177-185. doi: 10.1055/a-1861-7315. Epub 2023 Mar 1.
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.
格雷夫斯眼眶病（GO）严重表现的治疗仍然是一项挑战，需要良好的多学科合作。采用根据病情阶段调整的抗炎治疗以避免不可逆转的损害尤为重要。
讨论关于格雷夫斯眼眶病抗炎治疗的多中心随机治疗研究的最新结果以及新的治疗理念。
轻度GO病例仅通过补充硒和密切观察等待策略即可治疗。对于中度至重度活动期GO，主要治疗方法包括静脉注射类固醇（累积剂量4 - 5克），并对眼球运动受损的患者联合进行眼眶照射。在6周后治疗反应不足的患者中，应更换为其他免疫抑制剂。对于严重威胁视力的疾病，通常需要进行眼眶减压手术。随着基础研究增进了我们对GO潜在病理生理学的理解，已经有可能开发针对GO的靶向治疗方法。IGF - 1受体抗体替普罗珠单抗在一项III期试验中对治疗GO患者有效，并且很快应会在欧洲获批。
当前格雷夫斯眼眶病的治疗理念如下：首先进行抗炎治疗，然后对永久性缺陷进行手术矫正。由于靶向治疗的应用，这一理念可能很快会得到修正。
