THERAPEUTIC RESPONSES TO CORTICOSTEROIDS IN GRAVES OPHTHALMOPATHY

To elucidate the therapeutic responses to corticosteroids and prognost ic factors in the treatment of Graces' ophthalmopathy, 23 patients wit h Graves' ophthalmopathy were treated with intravenous methylprednisol one 0.5 g daily for 3 days, followed by prednisolone 40 mg daily. Dosa ge was reduced gradually to 10 mg daily over 4 weeks. The symptoms and signs of the eyes were recorded. Orbital computed tomography and urin ary glycosaminoglycan excretion testing were performed before treatmen t. We observed the effectiveness of treatment at 6 months as the endpo int of this study and classified the response as good or poor. We comp ared the differences in parameters between these two groups. The resul ts showed that 12 (52%) out of 23 patients had a good response, and th ree (25%) of those with a good response recovered completely. Corticos teroid therapy dramatically improved lacrimation, reduced soreness and congestion of the eyes and ameliorated exophthalmos, lagophthalmos an d extraocular muscle movement. Four (36%) of the 11 patients with a po or response had rebound of symptoms and/or signs after the dosage of p rednisolone was decreased. Those with a good response were usually you nger, and enlargement of the extraocular muscle Tvas also milder than in those with a poor response. This study demonstrated that corticoste roid therapy is effective in Graves' ophthalmopathy and that extraocul ar muscle size demonstrated by orbital computed tomography is a progno stic factor of therapy.