The Cooperation between the Ophthalmologist and the Endocrinologist in the Treatment of the Endocrine Orbitopathy

Overview

Authors of this study emphasize the requirement of the cooperation between the ophthalmologist and the endocrinologist in diagnostics and treatment of moderate and severe forms of endocrine orbitopathy (EO). Examinations necessary for diagnosis and possibilities of the systemic treatment are reported. Twenty patients within the group of 70 patients with EO, who had severe form of disease and underwent different combinations of corticosteroid therapy, immunosuppressive therapy, radiotherapy (RA) and orbital decompression were followed up. Authors recommend a dosage of Methylprednisolon (7–9 g) divided into pulses of 1000mg followed by pulses of 500mg given during 3 to 4 weeks (2–3 infusions per week). They recommend administering Prednison in 60–90 mg doses per day depending on weight of a patient. After daily maximum dose during the first two weeks, the authors recommend to decrease gradually the dose with the total treating period of minimum of a half a year. Decrease of visual acuity depending on EO appeared by 7 patients. It has been stabilized in 6 patients after the treatment of EO. Hand movement remained in one patient with severe neuropathy in spite of urgent orbital decompression. The intraocular pressure has been stabilized in 16 patients after treatment of EO (six patients do not require further antiglaucomatic therapy). The decrease of protrusion occurred in 8 patients after corticosteroid therapy (1–5 mm) and in 5 patients after orbital decompression (6–10 mm). Severe adverse events (herpetic infection, osteoporosis, steroid DM) were reported in 3 patients after repeated courses of corticosteroid therapy. Authors recommend early administration of intensive systemic corticosteroid therapy in active stage of the moderate forms of EO.

Key words:
Graves-Basedow disease, endocrine orbitopathy