RADIOTHERAPY IN THE MANAGEMENT OF GRAVES OPHTHALMOPATHY

Background: To report the results of radiotherapy for patients with fa ilure, adverse reactions or relative contraindications to the use of s teroids or immunosuppressants, by using newly developed quantitative i ndexes. Methods: Fourteen female and six male patients with Graves' op hthalmopathy were treated with radiotherapy between 1989 and 1996. Pri or to radiotherapy, eight patients received treatment with prednisone, four received immunosuppressants and four received a combination of b oth. Four patients with contraindications to steroids were initially m anaged with radiotherapy. Most of the patients received a dose of 24-2 8 Gy in 2 Gy fractions. We used the newly developed motility limitatio n index to assess extraocular motility. Results: Treatment was well to lerated. There have been no late complications. All 12 patients with s oft tissue signs such as edema, irritation, tearing and pain were impr oved. Proptosis did not improve or improved only slightly, 3 mm at bes t. However, proptosis in all but two has been stabilized and has not d eteriorated in the follow-up period. Most of the patients have experie nced an improvement of eye-muscle motility. Extraocular muscles that w ork for elevation were impaired more severely than the other muscles a nd this tended to remain. Of the 16 patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one pati ent required additional steroids, thus sparing the majority from stero id adverse reactions. Conclusion: Radiotherapy was effective in preven ting exacerbations of active inflammatory ophthalmopathy in patients w ith Graves' disease with minimal morbidity and thus eliminated the adv erse reactions associated with protracted corticosteroid use. The newl y developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles.