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Background/Aim. To evaluate the efficacy of methotrexate for the treatment of thyroid eye disease (TED). Methods. 36 consecutive patients with active TED, previously treated with corticosteroids but stopped due to the occurrence of side effects, were commenced on methotrexate therapy. Two different weekly doses were administered depending on the weight of the patient (7.5 mg or 10 mg). Clinical activity score (7-CAS), visual acuity (VA), ocular motility, exophthalmos, and eyelid position were retrospectively evaluated at 3, 6, and 12 months and compared with baseline data. Results. There was a statistically significant improvement in 7-CAS at 3, 6, and 12 months after treatment (P < 0.0001). There was no significant change in visual acuity. Ocular motility disturbances improved at 6 and 12 months (P < 0.001). There was no significant change in exophthalmos (mean 24 mm, SD 3 mm) or eyelid position (marginal reflex distance mean 6 mm, SD 1.5 mm) during the follow-up period. No side effects were registered. Conclusions. Methotrexate therapy is effective in reducing CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. Eventually, it might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids.

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Aims: To evaluate retinal nerve fiber layer (RNFL) thickness in eyes with Graves’ orbitopathy (GO), in eyes with ocular hypertension (OHT) and in a control group of healthy eyes. Methods: Observational, controlled cross-sectional study. We evaluated all patients with primary open-angle glaucoma (POAG) and all patients with GO and intraocular pressure >23 mm Hg in primary position examined from March 2006 to June 2007. Forty apparently healthy patients (80 eyes) were enrolled as a control group. Complete ophthalmic evaluation, visual field (VF) examination with the Humphrey Visual Field Analyzer and RNFL thickness measurement with optic nerve tracking optical coherence tomography (ONT-OCT; OCT/SLO, OTI, Toronto, Ont., Canada) were performed. Results: Among 116 eyes with POAG [58 patients, 32 males, 26 females, mean age 62 (46–71) years], RNFL was reduced in 87 eyes (75%, p = 0.05) when compared with the control group, and a good correlation was found between RNFL thickness and VF abnormalities (Spearman’s ρ 0.822; p = 0.001). Among 60 eyes [30 patients, 12 males, 18 females, mean age 56 (50–69) years] with GO and OHT, nonglaucomatous diffuse abnormalities of the VF were detected in 44 eyes (73.3%, p = 0.03), while RNFL thinning was present in 14 eyes (9 patients, 23.3%, p = 0.03). No correlation was found between RNFL thickness and VF abnormalities (Spearman’s ρ 0.365; p = 0.02). No significant differences in RNFL pattern were present between the group with GO, OHT and RNFL thinning and the group with POAG. Conclusions: In patients with GO and OHT, evaluation of RNFL thickness with ONT-OCT may represent an objective diagnostic technique for detecting optic neuropathy.

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