Abstract
Purpose Retrospective analysis of the effect of retrobulbar irradiation on exophthalmos, ductions and soft tissue signs in patients with Graves ophthalmopathy.
Methods We analysed the charts of 111 consecutive patients who were treated with retrobulbar irradiation according to standardised intake criteria between 1992 and 1997. After exclusion of patients who underwent other treatment (with steroids or orbital decompression) shortly before or within 6 months after irradiation, and on whom insufficient data were available, 90 patients were included. For these 90 patients, we analysed the exophthalmometry, ductions, soft tissue signs and visual acuity shortly before irradiation and after 3 and 6 months, respectively.
Results In the whole group, the Hertel value was on average 22 mm (SD 2.9) both before irradiation and after 3 and 6 months of follow- up. Separate analysis of data on 25 patients with bilateral exophthalmos of more than 24 mm also revealed no change in exophthalmos at follow- up. In the whole group, both abduction and elevation had improved by about 1 (SD 6.6; p = 0.05) after 3 months. This improvement has little clinical significance. In a subgroup of 14 patients who showed more than 10 of restricted eye motility in one or more directions, both abduction and elevation had increased by about 4 (SD 10; p = 0.02) at 3 and 6 months follow-up. Soft tissue signs had improved at 6 months after irradiation. We found no change in visual acuity after irradiation.
Conclusion Retrobulbar irradiation in Graves ophthalmopathy does not seem to reduce exophthalmos. It probably improves eye motility in patients with severe restrictions. The late improvement in soft tissue signs may either be a late effect of irradiation or be related to the natural history of the disease.
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References
Jacobson DH, Gorman CA . Endocrine ophthalmopathy: current ideas concerning aetiology pathogenesis and treatment. Endocr Rev 1984, 5: 200–20.
Weetman AP, McGregor AM, Ludgate M, Beck L, Mills PV, Lazarus JH, et al. Cyclosporin improves Graves' ophthalmopathy. Lancet 1983, 11: 486–9.
Burch FE . The exophthalmos of Graves' disease. Minn Med 1929, 12: 668–76.
Kriss JP . Graves' ophthalmopathy: etiology and treatment. Hosp Pract 1975, 10: 125–33.
Donaldson SS, Bagshaw MA, Kriss JP . Supervoltage orbital radiotherapy for Graves' ophthalmopathy. J Clin Endocr Metab 1973, 37: 276–85.
Van Ouwerkerk BM, Wijngaarde R, Henneman G, Van Andel JG, Krenning EP . Radiotherapy of severe ophthalmic Graves' disease. J Endocrinol Invest 1985, 8: 241–7.
Prummel MF, Mourits MP, Blank L, Berghout A, Koornneef L, Wiersinga WM . Randomised double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy. Lancet 1993, 342: 949–54.
Palmer D, Greenberg P, Cornell P, Parker RG . Radiation therapy for Graves' ophthalmopathy: a retrospective analysis. lnt J Radiat Oncol BioI Phys 1987, 13: 1815–20.
Kao SC, Kendler DL, Nugent RA, Adler JS, Rootman J . Radiotherapy in the management of thyroid orbitopathy: computed tomography and clinical outcomes. Arch OphthalmoI1993;111: 819–23.
Hurbli T, Char D, Harris J, Weaver K, Greenspan F, Sheline G . Radiation therapy for thyroid eye disease. Am J Ophthalmol 1985, 99: 633–7.
Wilson WBW, Prochoda M . Radiotherapy for thyroid orbitopathy. Arch Ophthalmol 1995, 113: 1420–5.
Werner Sc . Modification of the classification of the eye changes of Graves' disease. Am J Ophthalmol 1977;83:725–7.
Petersen LA, Kriss JP, McDougall IR, Donaldson SS . Prognostic factors in the radiotherapy of Graves' ophthalmopathy. Int J Radiat Oncol Bioi Phys 1990, 19: 259–64.
Perros P, Crombie L, Kendall-Taylor P . Natural history of thyroid associated ophthalmopathy. Clin Endocrinol 1995, 42: 45–50.
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Van Ruyven, R., Van den Bosch, W., Mulder, P. et al. The effect of retrobulbar irradiation on exophthalmos, ductions and soft tissue signs in Graves' ophthalmopathy: A retrospective analysis of 90 cases. Eye 14, 761–764 (2000). https://doi.org/10.1038/eye.2000.199
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DOI: https://doi.org/10.1038/eye.2000.199
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