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N. Curro, G. Vannucchi, D. Covelli, S. Simonetta, P. Beck-Peccoz, R. Ratiglia, M. Salvi; Treatment of Acute Disthyroid Optic Neuropathy With High Dose Steroids: Impact on the Disease's Surgical Management. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3923.
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aim of the present study is to evaluate retrospectively the effectiveness of two regimens of intravenous glucocorticoids (IVGC) in the treatment of acute disthyroid optic neuropathy (DON). DON is a sight-threatening clinical manifestation of Graves’ Orbitopathy (GO) which generally requires urgent surgical decompression of the orbit. IVGC have been used in an attempt to treat DON but may not change the outcome of the disease.
twelve patients with GO, 7 females and 5 males were studied. The diagnosis of DON was made testing the patient’s best corrected visual acuity (BCVA), visual field (automated Humphrey 30-2 sita fast), colour perception (HRR new edition), visual evoked potentials (pattern reversal checkerboard) and crowding of orbital apex at CT scan. Other neurological or ophthalmological diseases that could significantly affect visual function were excluded in all twelve patients. Patients were treated with high dose IVGC (5 with 500 mg and 7 with 1000 mg of methylprednisolone) administered weekly for three consecutive days of two consecutive weeks and strictly monitored in the following weeks.
after steroid therapy, surgical orbital decompression was the outcome in 8 patients, 3 of 7 treated with 1000 mg IVGC and all 5 treated with 500 mg IVGC whereas in 4 patients, all treated with 1000 mg IVGC, normal or near normal optic nerve function was permanently restored (BCVA within 1 Snellen line from baseline, less or equal than two error on the screening tables of the HRR, MD ≥ -5 dB, PSD ≤ 3 dB and fovea ≥ 30 dB on the automated visual field). There was a significant association between the mean administered dose of IVGC and DON outcome, the lower dose (500 mg) being always associated to orbital decompression (ANOVA p=0.04). While no significant association was found between the outcome and the cumulative dose (P=NS), the better outcome was significantly associated to a longer duration of GO (20.3±8.7 vs. 10.1±4.6 months, P=0.022).
these results suggest that even when treated with high dose IVGC, DON progresses in about 2 thirds of patients who require urgent surgical decompression. Steroid therapy may be successful in restoring optic nerve function in about 30% of patients with GO duration > 15 -18 months, when treated with IVGC and a mean infusion dose of 1000 mg. A larger multicenter study is necessary to confirm these data.
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