As a general guideline, one could consider a mean change of at least 6 points on one or both subscales an important change in daily functioning for patients. For more invasive therapies, a change of at least 10 points is recommended as a minimal clinically important difference.

Aims-To assess the prevalence of dysthyroid optic neuropathy (DON) in patients with diabetes mellitus (DM) and Graves' orbitopathy (GO) and to investigate the complications of surgery for GO in these patients. Methods-The records of 482 consecutive patients with GO referred in a 5 year period were studied. Those patients who also had DM were selected for further study. The prevalence of insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) was registered, as well as the prevalence and course of DON. In the patients who underwent surgery for GO the postoperative complications were recorded. Results-Out of 482 patients with GO, 15 (3.1%) also had DM. Eight (1.7%) had IDDM, 7 (1.4%) had NIDDM. Five patients (33.3%) three with IDDM and two with NIDDM developed DON with 50% improvement of visual acuity after treatment, whereas in the whole population of 482 GO patients 19 had DON (3.9%), showing 69.4% improvement of vision after treatment. 10 patients with GO and DM were operated for GO; in one of them an optic atrophy developed as a result of a postoperative haemorrhage directly after a three wall orbital decompression by coronal approach. No other postoperative complications occurred. Conclusions-The prevalence of IDDM in patients with GO is higher than in the normal population. DON occurs much more frequently in patients with GO and DM than in the total group of GO patients and seems to have a worse visual prognosis. (Br J Ophthalmol 1999;83:463-465) Graves' orbitopathy (GO) is a disorder of presumed autoimmune nature, closely related to Graves' thyroid disease.1 It is the most frequent orbital disorder in adults. Clinical findings typically consist of eyelid swelling, lid retraction, proptosis, acquired double vision, and impaired visual acuity. Blindness resulting from optic neuropathy, is the most threatening complication.2 Dysthyroid optic neuropathy (DON) is generally accepted as being caused by compression of enlarged extraocular muscles at the orbital apex; vasculopathy associated with smoking and diabetes may be an additional factor. [3][4][5] Diabetes mellitus (DM) is the most common endocrine disorder, with a significant morbidity and mortality. 6 The most prevalent form of DM is non-insulin dependent diabetes mellitus (NIDDM) which is caused by a combination of genetic and environmental factors resulting in insulin deficiency and insulin resistance. 7 8 Autoimmunity is supposed to be the major aetiological factor in insulin dependent diabetes mellitus (IDDM). 9 The major long term complication of DM is a generalised vasculopathy with basement membrane disease, blood flow disorders, and platelet abnormalities as the three basic mechanisms of vascular injury. 10In a previous study we found that the combination of DON and DM was associated with a worse response to orbital decompression.11 Therefore, we retrospectively studied those patients in whom the two disorders coexisted. The aims of this study were to assess the prevalence and course of DON in patie...

Aims-To investigate the prevalence and to discuss the necessity of treating elevated intraocular pressures (IOP) in patients with Graves' orbitopathy (GO). In addition, to study the eVects of orbital decompression and extraocular muscle surgery on IOP. Methods-The records of consecutive patients with GO referred in a 5 year period were studied and those selected, in which glaucoma medication had been prescribed, or a diagnosis of primary open angle glaucoma (POAG) or of ocular hypertension (>22 mm Hg) (OH) had been made. The necessity of treating these patients with glaucoma medication was questioned and the eVects of corticosteroids, orbital decompression, and extraocular muscle surgery on the IOP were evaluated. Results-Of 482 patients with GO, 23 (4.8%) met the inclusion criteria. Four patients (0.8%) had POAG, four had elevated IOPs and visual field defects consistent with dysthyroid optic neuropathy, and 15 (3.1%) had only elevated IOPs. Five patients with OH showed a permanent drop of IOP after orbital decompression, two had a marked decrease of their IOP after recession of the inferior rectus muscle. Conclusions-POAG has the same prevalence in the general Dutch population as in the GO subgroup. The combination of elevated IOPs and visual field defects in GO patients may be attributed to other mechanisms than obstructed aqueous outflow in the trabecular meshwork and should be treated accordingly. Orbital decompression and extraocular muscle surgery may lower the IOP in patients with GO. (Br J Ophthalmol 1998;82:754-757)

Outcome of orbital decompression for disfiguring proptosis in patients with Graves' orbitopathy using various surgical procedures General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible.

Objective: To assess whether methylprednisolone (MP) pulse therapy is efficacious in the treatment of moderately severe Graves' orbitopathy (GO). Design: Prospective, placebo (PL)-controlled, double-blind, randomized study. Methods: Fifteen previously untreated patients with active, moderately severe GO participated in the study; 6 patients received MP and 9 patients a PL. Moderately severe disease was defined using the NOSPECS classification of clinical signs of GO . Activity was measured with the clinical activity score (CAS). A dose of 500 mg MP or only solvent was administered intravenously, over three consecutive days, in four cycles at 4 weekly intervals (6 g of MP in total). Qualitatively, a successful treatment outcome was defined as an improvement in one major and/or two minor criteria in the worst eye at week 48. The major criteria were: improvement in diplopia grade; improvement in eye movement; a decrease in CAS of three points. The minor criteria were: decrease of eyelid retraction; decrease of proptosis; improvement in grade of soft tissue swelling; a decrease in CAS of two points. Results: The qualitative treatment outcome was successful at the end of the trial in five out of six (83%) patients receiving MP and in one out of nine (11%) patients given the PL (relative riskZ7.5; (95% confidence interval 1.1-49.3), PZ0.005). The treatment was well tolerated. Conclusions: In spite of the small number of patients, a significant difference in outcome was observed between MP-and PL-treated patients. We conclude that MP pulse therapy appears to be an effective treatment for active, moderately severe GO.European Journal of Endocrinology 158 229-237