Therapeutic Outcomes of High-Dose Intravenous Steroids in the Treatment of Dysthyroid Optic Neuropathy

• DOI: 10.1089/thy.2013.0445
• Publication Date: 2014-01-13T20:17:22Z
• Authors: Nicola Currò; Danila Covelli; Guia Vannucchi; Irene Campi; Giacinta Pirola; Simona Simonetta; Davide Dazzi; Claudio Guastella; Lorenzo Pignataro; Paolo Beck-Peccoz; Roberto Ratiglia; Mario Salvi
• Keywords: Male; Anti-Inflammatory Agents; Drug Resistance; Methylprednisolone; 03 medical and health sciences; 0302 clinical medicine; Humans; Glucocorticoids; Aged; Retrospective Studies; Aged, 80 and over; Dose-Response Relationship, Drug; Optic Nerve; Middle Aged; Decompression, Surgical; Combined Modality Therapy; Administration, Intravenous; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Combined Modality Therapy; Decompression, Surgical; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Glucocorticoids; Graves Ophthalmopathy; Humans; Male; Methylprednisolone; Middle Aged; Optic Nerve; Papilledema; Pulse Therapy, Drug; Retrospective Studies; Severity of Illness Index; Vision, Ocular; Drug Resistance; 3. Good health; Graves Ophthalmopathy; Pulse Therapy, Drug; Administration, Intravenous; Female; Follow-Up Studies; Papilledema

While pulsed intravenous methylprednisolone (iv-MP) has been shown to be effective and well tolerated in moderate severe Graves' orbitopathy (GO), limited data are available on dysthyroid optic neuropathy (DON). The objective of this retrospective study was investigate the efficacy iv-MP treatment DON seek parameters predictive response.Twenty-four patients (40 eyes) treated with from 2007 2012 were included study. Concurrent neurological or ophthalmologic diseases signs corneal exposure considered as exclusion criteria. Iv-MP administered daily for three consecutive days repeated following week. At six months, eyes not requiring surgery preserve visual function responsive treatment. Visual acuity, color sensitivity, field, discs analyzed at two four weeks, 3, 6, 12 months after Activity GO graded using a clinical activity score (CAS). characteristics studied by comparison those nonresponsive eyes.At 17 40 (42.5%) had complete recovery spared surgical decompression. field improved significantly almost all eyes, but inactivated (CAS<4) only that permanently responded (p<0.01). CAS weeks good predictor response (cutoff ≥4; 66.7% 76.9% specificity). Optic disc swelling diagnosis highly unresponsiveness (34% 100% baseline, high >5; 40.2% 94.1% specificity) severely altered mean defect ≤6.31 dB; 73.9% 58.8% associated steroids. No major side effects observed.High-dose restoring about 40% treated. When successful, it generally induced inactivation orbital disease within normalization one month. presence persistent active predictors