title: [Retrobulbar irradiation for Graves' ophthalmopathy -- long-term results].
abstract: BACKGROUND
  Significance of retrobulbar irradiation in patients suffering form Graves' ophthalmopathy, though established since almost one century, is subject of scientific debate. The present study investigated the effect of retrobulbar irradiation using a standardized protocol focussing on long term results.
  
  
  METHODS
  Between 1981 and 1997, 104 patients treated by retrobulbar irradiation (10 to 20 Gray) due to Graves' disease. Twenty-nine of these underwent irradiation as sole treatment (mean follow-up 57 months), while in the remaining 75, it was combined with a systemic steroid treatment (mean follow-up 40 months). Patients were evaluated regarding proptosis, intraocular pressure, lid signs, motility as well as subjective assessment of double vision and retrobulbar pain.
  
  
  RESULTS
  While proptosis remained unchanged, lid signs, chemosis and intraocular pressure showed slight and statistically significant improvement. However, these findings were considered to be clinically insignificant. Retrobulbar pain was improved in 75 % of patients. 25 % of patients showed improved motility, 75 % remained stable, and in none of them was there a deterioration of ductions. Results proved stable even in long-term follow-up. 25 % per cent of patients underwent a surgical procedure one year after radiotherapy.
  
  
  CONCLUSIONS
  In our series, we could not demonstrate an additional benefit of systemic steroids when combined with retrobulbar irradiation. Up to sixteen years after treatment, no treatment-related adverse reaction was seen. We found a remarkable improvement in ocular motility. This holds even more true in comparison to the natural course of the condition. Retrobulbar irradiation seems to shorten the duration of the disease, thus allowing earlier performance of eventual rehabilitative surgery.
authors.affiliation: Augenklinik, Johannes Gutenberg-Universität, Mainz.
authors.forename: Susanne
authors.initials: S
authors.lastname: Pitz
authors.forename: George
authors.initials: G
authors.lastname: Kahaly
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Rösler
authors.forename: Frank
authors.initials: F
authors.lastname: Krummenauer
authors.forename: Bernd
authors.initials: B
authors.lastname: Wagner
authors.forename: Michael
authors.initials: M
authors.lastname: Stübler
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005133:Eye Movements / Q000528:radiation effects; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000175:diagnosis / Q000532:radiotherapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007429:Intraocular Pressure / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000532:radiotherapy; D009915:Orbit / Q000528:radiation effects; D011879:Radiotherapy Dosage; D013256:Steroids; D014792:Visual Acuity / Q000528:radiation effects
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013256:Steroids