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Efficacy of combined orbital radiation and systemic steroids in the management of Graves' orbitopathy

 Ji Won Kim  ;  Sun Hyup Han  ;  Byeong Jae Son  ;  Tyler Hyungtaek Rim  ;  Ki Chang Keum  ;  Jin Sook Yoon 
 Graefes Archive for Clinical and Experimental Ophthalmology, Vol.254(5) : 991-998, 2016 
Journal Title
 Graefes Archive for Clinical and Experimental Ophthalmology 
Issue Date
Combined Modality Therapy ; Dose Fractionation ; Exophthalmos/physiopathology ; Female ; Glucocorticoids/administration & dosage* ; Graves Ophthalmopathy/drug therapy* ; Graves Ophthalmopathy/physiopathology ; Graves Ophthalmopathy/radiotherapy* ; Humans ; Male ; Methylprednisolone/administration & dosage* ; Middle Aged ; Ocular Motility Disorders/diagnostic imaging ; Ocular Motility Disorders/physiopathology ; Oculomotor Muscles/diagnostic imaging ; Oculomotor Muscles/physiopathology ; Orbit/diagnostic imaging ; Orbit/radiation effects* ; Pulse Therapy, Drug ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome
Graves’ orbitopathy ; Orbital radiation ; Systemic steroids ; Thyroid-associated orbitopathy
PURPOSE: To compare the efficacy and safety of combination therapy with orbital irradiation and systemic steroids versus steroid monotherapy in the management of active Graves' orbitopathy (GO). METHODS: The clinical charts of 127 patients with active inflammation due to GO who received intravenous steroid pulse therapy as a first-line treatment with or without orbital radiotherapy between 2010 and 2014 were reviewed. Patients were divided into two treatment groups: 1) combined orbital radiotherapy and steroid pulse therapy (SRT group) and 2) steroid pulse therapy only (ST group). Primary outcome measures included clinical activity score (CAS); NOSPECS classification; ocular motility impairment; and exophthalmos at 1, 3, 6, and 12 months after treatment. The secondary outcome measure was the change in orbital, extraocular muscle (EOM), and fat volume after treatment measured by orbit computed tomography. RESULTS: Sixty-eight patients were included in the SRT group, and 59 patients were in the ST group. In both treatments, CAS and NOSPECS were significantly reduced. In the comparison of the degree of change from baseline between the groups, the SRT group demonstrated more improvement in NOSPECS and scores of ocular motility. Orbital, EOM, and fat volume significantly decreased in the SRT group; however, only fat volume was reduced in the ST group. Compressive optic neuropathy after treatment developed in 0 % of the SRT group and 3.4 % (2/59) of the ST group. Reactivation of inflammation occurred in 11.8 % (8/68) of the SRT group and 28.8 % (17/59) of the ST group. CONCLUSIONS: Orbital radiotherapy in combination with steroid treatment significantly improved ocular motility by reducing EOM volume in patients with active GO.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
금기창(Keum, Ki Chang) ORCID logo https://orcid.org/0000-0003-4123-7998
윤진숙(Yoon, Jin Sook) ORCID logo https://orcid.org/0000-0002-8751-9467
임형택(Rim, Tyler Hyungtaek)
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