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Orbital Radiotherapy Combined With Corticosteroid Treatment for Thyroid Eye Disease-Compressive Optic Neuropathy.
- Source :
-
Ophthalmic plastic and reconstructive surgery [Ophthalmic Plast Reconstr Surg] 2018 Mar/Apr; Vol. 34 (2), pp. 172-177. - Publication Year :
- 2018
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Abstract
- Purpose: To evaluate the effectiveness of orbital radiotherapy (ORT) in the treatment of thyroid eye disease (TED)-compressive optic neuropathy.<br />Methods: A retrospective review of patients with corticosteroid-responsive compressive optic neuropathy due to TED treated with ORT. Study was conducted in compliance with Health Insurance Portability and Accountability Act. One hundred four patients (163 orbits) with a mean age of 61.7 years met inclusion criteria. Seventy-four percent (77/104) were female, and 32.7% (34/104) were current or previous smokers. A total absorbed dose of 2000 cGy fractionated in 10 treatment doses over the course of 2 weeks was administered to the retroocular tissues according to a standard protocol. The primary end point was failure of ORT, defined as persistent optic neuropathy following completion of radiotherapy that mandated urgent orbital decompression surgery.<br />Results: Ninety-eight of 104 (94%) patients or 152 of 163 (93.3%) orbits did not require orbital decompression surgery during the acute phase. Patients who responded successfully to ORT had similar improvements in visual acuity, color vision, Humphrey threshold visual field testing, and afferent pupillary defects compared with patients who failed ORT and underwent urgent decompression surgery. Only 36.7% of successfully treated patients ultimately underwent elective surgery, including orbital decompression, strabismus, or eyelid surgery, during the inactive phase of TED.<br />Conclusions: The data from this study, the largest retrospective review reported to date, supports the use of ORT in eyes with corticosteroid-responsive TED-compressive optic neuropathy. ORT may favorably alter the natural history of active-phase TED by preventing recurrent compressive optic neuropathy after withdrawal of corticosteroids.
- Subjects :
- Adult
Aged
Color Vision physiology
Combined Modality Therapy
Female
Humans
Male
Middle Aged
Retrospective Studies
Visual Acuity physiology
Adrenal Cortex Hormones therapeutic use
Graves Ophthalmopathy drug therapy
Graves Ophthalmopathy physiopathology
Graves Ophthalmopathy radiotherapy
Nerve Compression Syndromes drug therapy
Nerve Compression Syndromes radiotherapy
Optic Nerve Diseases drug therapy
Optic Nerve Diseases physiopathology
Optic Nerve Diseases radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1537-2677
- Volume :
- 34
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Ophthalmic plastic and reconstructive surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29517594
- Full Text :
- https://doi.org/10.1097/IOP.0000000000001003