Orbital radiotherapy and corticosteroids are two well-established medical treatments for severe Graves’ ophthalmopathy. In this report we analyze the results obtained by the combination of orbital radiotherapy and systemic or retrobulbar corticosteroids in patients with severe Graves’ ophthalmopathy. Orbital cobalt radiotherapy was carried out by a cobalt unit, delivering a total of 2,000 rads to each eye in 10 daily doses. Systemic corticosteroid treatment was started with 70–80 mg methylprednisolone/day for 2–3 weeks with subsequent progressive reduction of the dose until discontinuation of the drug after 5–6 months. Retrobulbar corticosteroid therapy was performed by 14 bilateral injections of 40 mg methylprednisolone acetate at 20- to 30-day intervals. Results were evaluated both on clinical grounds and by numerical scoring (ophthalmopathy index, OI). Excellent or good responses were obtained in the majority of 72 patients by combined treatment with orbital cobalt radiotherapy and systemic corticosteroids. Soft tissue changes, newly developed eye muscle dysfunction and optic neuropathy showed the most beneficial effects from treatment, whereas proptosis, corneal lesions and long-standing eye muscle abnormalities responded to a lesser extent. The results of a controlled clinical trial showed that the combined treatment was more effective than the administration of systemic methylprednisolone alone. Because relevant side effects of systemic corticosteroid therapy were observed in 4 cases, the clinical validity of retrobulbar corticosteroids in substitution for systemic corticosteroids was evaluated in 44 patients. Excellent or good responses were observed in 25% of these patients, slight responses being obtained in 55% and no change in 20%. Regression or partial improvement was observed in most cases with soft tissue changes and optic neuropathy, while proptosis, corneal lesions and extraocular muscle involvement were less responsive. The results of combined treatment with orbital radiotherapy and systemic or retrobulbar corticosteroids were directly compared in two groups of patients, giving more satisfactory results in the former group, both on clinical grounds and in terms of changes of the OI. In conclusion, retrobulbar corticosteroids associated with orbital radiotherapy are not as effective as systemic corticosteroids combined with orbital irradiation in the treatment of Graves’ ophthalmopathy. Thus, we limit the use of retrobulbar steroids to patients with contraindications to the systemic administration of steroids.

Keywords:
Exophthalmos, Graves’ opthalmopathy, Orbital radiotherapy, Corticosteroids
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© 1987 S. Karger AG, Basel
1987
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