[The influence of treatment of progressive edematous infiltrative ophthalmopathy on intraocular pressure].
OBJECTIVE
To evaluate the influence of systemic steroid therapy and retrobulbar irradiation on intraocular pressure (IOP) in patients with infiltrative--oedematous Graves' ophthalmopathy.


METHODS
We examined 76 patients divided into 3 groups: I--treated by irradiation only (15 patients), II--treated by irradiation and oral prednisone therapy (26 patients), III--treated by irradiation and intravenous methylprednisolone pulse therapy (35 cases). All patients underwent full ophthalmological examination (including IOP measurement, perimetry and gonioscopy) before, during, immediately after and 2-20 months after treatment.


RESULTS
Increased IOP (21-31 mm Hg) was observed in 54 patients (71%) before treatment. The iridocorneal angle was open in all eyes. Changes in perimetry were not characteristic for glaucoma. IOP was higher in patients with more severe ophthalmopathy. We recorded transient increase of IOP during treatment in only 3 patients. Increased IOP immediately after therapy was observed in 16 patients with severe symptoms and signs of ophthalmopathy: in group I--4/15 (27%), in group II--4/26 (15%), in group III--8/35 (23%). Higher IOP was recorded in 10 patients two to twenty months after completion of treatment: from group I--4/15 (27%), from group II--1/26 (4%) and from group III--5/35 (14%). In 6 of these 10 persons we observed recurrence of ophthalmopathy, in 4 patients higher IOP was the only deviation, they needed local therapy. The mean values of IOP were lower in patients treated by steroid therapy in comparison to patients treated by irradiation only. The most rapid improvement of clinical status was observed in patients treated by methylprednisolone pulse therapy.


CONCLUSIONS
The increase of IOP in patients with Graves' ophthalmopathy correlates with severity and duration of eye disease. Systemic steroid therapy is more efficient in reduction of IOP than irradiation of the retrobulbar tissue. Our results suggest that combined therapy is a preferable method of treatment of progressive ophthalmopathy, including cases with increased intraocular pressure.
Rutecka-Debniak
A
A
Katedry i Kliniki Okulistyki (WS) PAM w Szczecinie.
Krzystolik
Z
Z
Pilarska
K
K
Krzyzanowska-Swiniarska
B
B
Syrenicz
A
A
Jarema
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003131:Combined Modality Therapy; D018450:Disease Progression; D004487:Edema / Q000175:diagnosis* / Q000628:therapy*; D005128:Eye Diseases / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome