[Ophthalmologic aspects of treating optic neuropathy during the course of Graves-Basedow disease]

The aim of the present study is to evaluate the efficacy of conservative treatment of optic neuropathy in the course of Graves' disease. Nineteen patients with neuropathy out of 520 patients with Graves' disease, including 15 women and 4 men were treated. Age of the patients ranged from 36 to 69 years, mean age was 51.3. In all patients thyroid function was normalized, 4 patients underwent strumectomy. Bi- and unilateral neuropathy was found in 13 and 6 cases respectively. The therapy consisted of high-dose steroids (Prednisone in 12 cases or Dexamethasone i.v. in 3 cases) or they were combined with gamma cobalt-60 irradiation of orbit tissues (2000 c Gy in 10 fractions) in 8 cases. In 2 cases radiotherapy alone was performed. Two cases were excluded from treatment because of optic atrophy during the first examination. In all patients full ophthalmological investigation, ultrasonography and computed tomography of the orbit before and after the treatment were performed. Follow-up ranged from 5 to 46 months, mean 21.4. Improvement of visual acuity and perimetry (p < 0.05) after the treatment was observed and changes of the fundus after the treatment were significantly (p = 0.000) improved. Exophthalmos significantly decreased (p < 0.05) but only in the right eye. In all patients the therapy reduced the ophthalmopathy index from mean 7.5 to 4.1 (p = 0.000).

1. Early diagnosis and appropriate, constant conservative treatment of optic neuropathy in Graves' disease prevent from blindness and surgical intervention. 2. Corticotherapy in combination with radiotherapy of the orbit is a beneficial method of the treatment of optic neuropathy in Graves' disease.