Effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves' ophthalmopathy.
OBJECTIVE
To evaluate the effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves' ophthalmopathy.


METHODS
We selected 41 Japanese patients (age range, 21-76 years; mean = 49 years) who had active Graves' ophthalmopathy among 205 consecutive patients examined at Sapporo Medical University Hospital between 1997 and 1999. In a prospective study, we investigated the effect on the 41 patients of high-dose intravenous methylprednisolone pulse therapy (1 g/day x 3 days x 3 times) followed by 3-month oral prednisone therapy. Coronal computed tomography (CT) of the orbit, exophthalmometry and monocular fixation field measured by Goldmann perimetry were carried out before the steroid pulse therapy, and 1 and 6 months after the steroid pulse therapy. The maximum coronal section area of the rectus muscle in each eye was measured using an orbital CT image.


RESULTS
Extraocular muscle hypertrophy was significantly reduced 1 and 6 months after the pulse therapy (paired t-test, P <.01), and was not significantly different between 1 and 6 months after the pulse therapy. Proptosis was not significantly reduced by the pulse therapy. Monocular fixation fields were measured in 34 patients with diplopia, and limitation of eye movements was improved in 15 patients (44%) by the pulse therapy. In the other patients, improvement of the limitation was not detectable by the test of the monocular fixation field.


CONCLUSIONS
The treatment in this study is effective for extraocular muscle hypertrophy, and relapse was minimum within 6 months. However, this treatment has limited effect on limitation of eye movements and less effect on proptosis.
Ohtsuka
Kenji
K
Department of Ophthalmology, Sapporo Medical University, School of Medicine, Hokkaido, Japan.
Sato
Akihiko
A
Kawaguchi
Satoshi
S
Hashimoto
Masato
M
Suzuki
Yasuo
Y
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D004172:Diplopia / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005133:Eye Movements / Q000187:drug effects; D005260:Female; D005403:Fixation, Ocular; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006111:Graves Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D006984:Hypertrophy; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000187:drug effects / Q000473:pathology; D011446:Prospective Studies; D020551:Pulse Therapy, Drug; D012008:Recurrence; D013997:Time Factors; D015349:Vision, Monocular; D058609:Visual Field Tests
D005938:Glucocorticoids; D008775:Methylprednisolone