[Driving competency after combined treatment with methylprednisolone and orbital radiotherapy for endocrine...

Graves' orbitopathy (GO) in its moderate to severe expression is a disfiguring and disabling disease that profoundly influences activities of daily living. Intravenous steroids and orbital radiotherapy are effective treatments for moderate to severe active GO. We examined the ophthalmological outcomes regarding daily life activities, such as driving competency.

In a retrospective case series, we evaluated the data for 21 consecutive patients with moderate to severe and active GO (14 women and seven men) treated with combined orbital radiotherapy (13 Gy) and intravenous methylprednisolone (500 mg weekly for 6 consecutive weeks and 250 mg weekly for consecutive 6 weeks).

The pretreatment mean clinical activity score of 5.2 points (SD ± 0.9) decreased significantly to 2.7 points (SD ± 1.1) in the 12-month follow-up. Analysis of all ocular symptoms showed significant changes for four parameters with different time frames. Inflammatory eye signs--e.g., pain and pressure sensation, caruncle inflammation, and eyelid swelling, including exophthalmos--improved significantly within the first 3 months. Eyelid swelling was significantly reduced 6-12 months after therapy. However, there was no significant improvement of eye motility. Despite anti-inflammatory treatment, 11 patients (52.3%) were not fit to drive a car under binocular conditions. In eight of these patients, additional strabismologic therapy, including prisms or strabismus surgery, was successful.

The combined therapy of intravenous corticosteroids and orbital radiotherapy reduced inflammatory ophthalmological signs in different time frames. In most cases, strabismologic intervention, including eye muscle surgery, was necessary to restore driving competency.