Effect of steroid pulse therapy with and without orbital radiotherapy on Graves' ophthalmopathy.
OBJECTIVE
To report the effect of high-dose intravenous corticosteroid pulse therapy with and without orbital radiotherapy on Graves' ophthalmopathy.


METHODS
Nonrandomized clinical trial.


METHODS
We selected 39 Japanese patients (age range, 22-64 years; mean, 48 years; 31 women, 8 men) who had active Graves' ophthalmopathy among 195 consecutive patients. In the first 20 patients, high-dose intravenous methylprednisolone pulse therapy (1 g per day for 3 successive days, repeated 3 times within 3 weeks) followed by 24-Gy orbital radiotherapy was performed. In the other 19 of the 39 patients, high-dose intravenous methylprednisolone pulse therapy without orbital radiotherapy was performed. Coronal computed tomography (CT) of the orbit and exophthalmometry were performed before the corticosteroid pulse therapy, and 1 and 6 months after the corticosteroid pulse therapy. The maximum coronal section area of the most hypertrophic rectus muscle in each eye was measured based on orbital CT imaging.


RESULTS
Clinical findings at study entry were not significantly different between the two groups. No significant difference was found in the maximum coronal section area of the most hypertrophic rectus muscle and the results of exophthalmometry measurements in both groups before the therapy. Extraocular muscle hypertrophy was significantly reduced 1 month and 6 months after the therapy (P < .01) in both groups. However, no beneficial therapeutic effect on proptosis was observed in either group at 1 month and 6 months after the therapy. No significant difference in the therapeutic effect on extraocular muscle hypertrophy and proptosis was found between the two groups.


CONCLUSIONS
Orbital irradiation after corticosteroid pulse therapy had no beneficial therapeutic effects on rectus muscle hypertrophy or proptosis of active Graves' ophthalmopathy during the 6-month follow-up period.
Ohtsuka
Kenji
K
Department of Ophthalmology, Sapporo Medical University, School of Medicine, Sapporo, Japan. kohtsuka@sapmed.ac.jp
Sato
Akihiko
A
Kawaguchi
Satoshi
S
Hashimoto
Masato
M
Suzuki
Yasuo
Y
D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006111:Graves Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D006984:Hypertrophy; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000473:pathology; D009915:Orbit / Q000000981:diagnostic imaging / Q000528:radiation effects*; D020551:Pulse Therapy, Drug; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005938:Glucocorticoids; D008775:Methylprednisolone