June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Reducing Diplopia in patients with graves orbitopathy – efficacy of intravenous glucocorticoids with and without combination of orbital radiotherapy
Author Affiliations & Notes
  • Michael Oeverhaus
    Center for Ophthalmology, University Hospital Essen, Essen, Germany
  • Tobias Witteler
    Department of Medical Oncology, Kliniken Essen-Mitte, Essen, Germany
  • Hildegard Lax
    Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
  • Joachim Esser
    Center for Ophthalmology, University Hospital Essen, Essen, Germany
  • Anja Eckstein
    Center for Ophthalmology, University Hospital Essen, Essen, Germany
  • Footnotes
    Commercial Relationships   Michael Oeverhaus, None; Tobias Witteler, None; Hildegard Lax, None; Joachim Esser, None; Anja Eckstein, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5153. doi:
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      Michael Oeverhaus, Tobias Witteler, Hildegard Lax, Joachim Esser, Anja Eckstein; Reducing Diplopia in patients with graves orbitopathy – efficacy of intravenous glucocorticoids with and without combination of orbital radiotherapy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5153.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Uncertainty exists for the effects of anti-inflammatory therapy on diplopia and reduced motility in patients with graves orbitopathy (GO). We performed a retrospective clinical study to analyze the changes of motility and diplopia of patients with moderate severe, active GO.

Methods : We searched in our GO database (n=3655) for patients with untreated moderate to severe, active GO, with onset ≤12 months and intravenous glucocorticoids (GCs) therapy with or without combination of orbital radiotherapy. Of 543 identified patients, n=148 met all inclusion criteria, including follow-up data 3 and 6 months after therapy. We analyzed besides CAS, NOSPECS and proptosis, also the monocular motility, field of single vision (FSV) and driving competency of the patients.

Results : 76 patients were treated with iv GCs, 72 patients additionally with orbital radiotherapy. Both groups had comparable cumulative doses and duration of GO. Both therapies inactivated the GO (CAS ≤2) after 6 months at a similar level (65,8% vs. 63,8%). The combination of iv GCs and orbital radiotherapy lead after 6 months to a significant improvement of prior reduced motility (p=0.0001) and increase of the field of binocular single vision in patients with diplopia (p=0,0467), whereas the patients with iv GCs alone showed no significant improvement (p=0.1733) of both symptoms. Driving competency was restored with both therapies in less than 30% of the patients.

Conclusions : Although the rate of inactivation with both therapies was nearly identical, only the orbital radiotherapy was fit to improve quality-of-life relevant symptoms as reduced motility and diplopia, which endorses combinatory therapy as first-line of treatment in patients with reduced motility. However, even these patients mostly did not regain driving competency. Patients should be informed about the limited effect of anti-inflammatory therapy on eye motility and diplopia and surgical interventions should be evaluated at an early level. As other publications showed higher inactivation success with higher dosages, but also lower inactivation with higher dosages in patients with longer GO duration, further prospective studies are needed to determine the best time and dose to reduce activity and more importantly relevant symptoms as diplopia.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

 

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