The results of 39 patients with severe Graves' ophthalmopathy (GO), who were monitored by magnetic resonance imaging (MRI) and tonography before and after combined immunosuppressive treatment with cyclosporine and corticosteroids, are presented. A correlation was found between the decrease in T2 relaxation time of the superior, medial, and inferior rectus muscle (p < 0.01) and the response to the immunosuppressive treatment. Muscle thickness and intraocular pressure showed less improvement (p < 0.05). The infiltrative eye signs improved partially in correlation with the T2 relaxation time. By distinguishing inflammation of the extraorbital muscles from fibrosis, the T2 relaxation time can help to select patients that benefit from immunosuppressive treatment as well as to monitor the therapeutic effect.
Ten patients with severe Graves' ophthalmopathy, resistant to other therapeutic regimens were treated with cyclosporin A (CyA) over a period of 6 months. Clinically, 9 patients improved, 2 of them only after addition of corticosteroids. Intra-ocular tension on upward gaze decreased in all of these 9 patients (P < 0.01). In 6 patients there was a significant decrease in eye muscle thickness under the treatment (P < 0.05) as determined by computerized tomography. Side effects (e.g., paraesthesia, proteinuria) which were observed under higher doses of CyA, disappeared after lowering the dose. In only one out of 3 patients with hypertension an antihypertensive medication became necessary.
Magnetic resonance imaging (T1- and T2-weighted) was performed in 65 patients with Graves' disease. In addition, T2 relaxation times of each ocular muscle were measured. Of the muscles thus studied, 54.8% showed a thickening in coronary tomograms. An interaction between the optic nerve and the thickened ocular muscles at the apex of the orbit was suspected in 30.1%. It could not be confirmed that the thickening of the muscles and the T2 value were related. However, there was a high correlation between the rise in intraocular pressure and the T2 relaxation time. These results imply that the T2 relaxation time is extremely useful in interpreting the activity of Graves' disease and provide a diagnostic tool of prognostic value in monitoring and treating this disease.
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