[Combined therapy with cyclosporin A and cortisone in endocrine Basedow endocrine orbitopathy: successful use in...

This study reports our experience with a combined treatment with cyclosporin A (Cy A) and cortisone in patients with Graves' ophthalmopathy (GO), all of whom had compressive optic nerve disease (CON). The therapy was performed in 8 patients (6 females, age range: 40 to 76 years) with normal liver and kidney function and classical Graves' disease, except for 1 male, who had normal thyroid function and no detectable thyroid antibodies. 5 patients were euthyroid on methimazole, 2 patients were off thyrostatic treatment for 5 and 2 years. 3 patients have had high-dose cortisone (100 mg/die) treatment for GO before the study. Visual field defects were reported by the patients 1 week before start of therapy and evaluated by computerized visual field measurements (CVFM). The treatment consisted of Cy A in a dose which aimed at through levels between 100 and 300 ng/ml (RIA method) for 2 to 6 months and of methylprednisolone in a starting dose of 1 mg/kg body weight, tapered gradually to a maintenance dose of 10 mg/day for 6 to 12 months. CON disappeared completely in all patients. The thickening of affected eye muscles decreased in 5 patients, disappeared in 1 and remained unchanged in 2 patients. The shortest period for a measurable effect (either by echography or by CVFM, performed every week the first month and then every 3 months) was 1 week; the longest 1 month. The follow-up of the patients (range 6 months to 2.5 years) showed a relapse only in 1 patient. 2 patients were lost to follow-up 1 year after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)