Optic Neuropathy Following Orbital Irradiation for Graves’ Ophthalmopathy: A Case Report and Literature Review

Sánchez-Orgaz, Margarita; Grabowska, Anna; Royo-Oreja, Arantza; Durán, M. Asencio; Romero-Martín, Ricardo; Arbizu-Duralde, A.

doi:10.3109/01676830.2011.603458

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…The highest daily highest dose (1 gram of methylprednisolone) showed worsening, unchanged, and improved VA in 3 separate patients. 17,35,36 A subgroup analysis of cases treated within 2 weeks of presentation and normal discs on presentation was conducted. Of the 9 patients, only 3 (33.3%) had improved or stable VA ≤1 logMAR.…”

Section: Resultsmentioning

confidence: 99%

Treatment and prophylaxis of radiation optic neuropathy: A systematic review and meta-analysis

Joarder

Micieli

2022

European Journal of Ophthalmology

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Purpose Radiation optic neuropathy (RON) generally follows radiation therapy that exceed 50 Gy to the visual axis and occurs within three years of therapy. Currently, there are no universally accepted treatments or prophylaxis for RON. The review aimed to examine the efficacy of all treatments and prophylaxis for RON. Methods MEDLINE, Embase, the Cochrane Library, and gray literature were searched to December 2020. Studies on treatment(s) and/or prophylaxis of RON were included. Results were meta-analyzed using a random-effects model. Primary outcomes included the proportions of patients who experienced improvement, no change, or worsening of visual acuity (VA) for each treatment. Secondary outcome was the incidence of RON for studies on prophylaxis. Results Overall, 50 studies (n = 5397) were included. Meta-analysis (n = 1752) showed significantly lower incidence of RON in patients who underwent intravitreal anti-VEGF prophylaxis compared to control (RR 0.64, 95%CI [0.48, 0.86]) for uveal melanoma. Intravitreal anti-VEGF injections (n = 68), hyperbaric oxygen therapy alone (n = 14), and pentoxifylline (n = 5) resulted in improved or stable vision ≤1 logMAR in 54.5%, 42.9%, and 40.0% of patients, respectively. Systemic corticosteroids (n = 82), anticoagulants (n = 12), and systemic bevacizumab (n = 7) showed improved or stable vision ≤1 logMAR in 17.1%, 33.3%, and 14.3% of patients, respectively. Overall risk of bias was low, but evidence was limited to retrospective studies. Conclusion Intravitreal anti-VEGF injections reduced incidence of RON in irradiated uveal melanoma patients. Systemic corticosteroids, systemic bevacizumab, and warfarin alone are likely ineffective treatments. Early hyperbaric oxygen therapy and intravitreal anti-VEGF injections were most effective among those investigated and require further investigation.

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Section: Resultsmentioning

confidence: 99%

Treatment and prophylaxis of radiation optic neuropathy: A systematic review and meta-analysis

Joarder

Micieli

2022

European Journal of Ophthalmology

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“… 8 Despite the widespread use of these modalities over decades for TED, the literature is mostly comprised of retrospective studies, Case reports and small case series which now guide practice patterns in the treatment of DON. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 There has only been one prospective, randomized controlled trial (RCT) to compare corticosteroids versus corticosteroids and surgical decompression for DON. 12 In this study, Wakelkamp et al reported similar initial outcomes after medical decompression and surgical decompression, and found that immediate surgical decompression did not result in better visual outcomes nor did it preclude the use of corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 13 , 14 , 15 External beam radiation has also been used for decades for the treatment of active TED including patients with DON. 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 Radiation therapy, like corticosteroids, dampens the inflammatory cascade in active TED. 35 …”

Section: Discussionmentioning

confidence: 99%

Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: A multicenter study

Sears

Wang

Bailey

et al. 2021

American Journal of Ophthalmology Case Reports

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Purpose To study post-interventional findings in patients with dysthyroid optic neuropathy (DON) treated with teprotumumab. Observations In this multicenter observational Case series , patients with DON were treated with teprotumumab, an insulin-like growth factor I receptor inhibitor (10 mg/kg for the first infusion then 20 mg/kg for subsequent infusions, every three weeks for a total 8 infusions). This study included patients with acute and chronic thyroid eye disease (TED) with DON who had failed conventional therapies and were not candidates for surgical decompression. Data collected included best corrected visual acuity (BCVA), color vision, RAPD when present, and orbital CT or MRI. Proptosis, clinical activity score (CAS), Gorman diplopia score (GDS), and Humphrey visual fields (HVF) were also evaluated. Ten patients (6 women, 4 men) with an average age 64 years old were included in this study. Mean follow up after completion of infusions was 15 weeks. Baseline visual acuity (VA) impairment ranged from hand motion (HM) to 20/25 in affected eyes. All patients had pre-treatment orbital CT or MRI that confirmed orbital apex compression. Seventy percent of patients had objective improvement in DON after 2 infusions of teprotumumab measured as significant improvement in visual acuity, resolution of RAPD, or both. After completion of treatment, affected eyes had a mean BCVA improvement of 0.87 logMAR (p=0.0207), proptosis reduction of 4.7 mm (p<0.00001), CAS improvement of 5.25 points (p<0.00001), and GDS improvement of 0.75 points (p=0.160). All 6 patients who presented with an RAPD had resolution or improvement of RAPD. All 7 patients who presented with color vision deficits had normalization or improvement of color vision. Conclusions and Importance Teprotumumab infusions resulted in medical decompression and objective resolution or improvement of dysthyroid optic neuropathy. Most patients had rapid improvement of visual acuity and reversal of RAPD. Post-infusion imaging demonstrated reduction in extraocular muscle size that correlated with improvement in visual dysfunction. However, patients who presented with longstanding severe visual loss had limited improvement. There was no recurrence of DON after completion of teprotumumab in our cohort.

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“…No significant difference was detected between the two groups; suggesting that the addition of 24 Gy irradiation to IV prednisolone had no extra therapeutic benefit. In addition, the radiation may have caused radiation optic neuropathy if the cumulative dose of radiation exceeded 50 Gy or if radiation fractions of >2 Gy were used ( 20 ). In a survey, 91% of the responding members of the European Thyroid Association indicated that they would treat an index patient who had active and severe TAO with glucocorticoids, and 71% would immediately start with IV glucocorticoids ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Short and long-term effects of high-dose intravenous methylprednisolone pulse therapy on thyroid-associated ophthalmopathy

Liu¹,

Shu²,

Qin³

et al. 2016

Experimental and Therapeutic Medicine

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The majority of previous studies on high-dose intravenous methylprednisolone pulse (IVMP) therapy have observed the clinical conditions of patients prior to and following treatment without any long-term follow-up, and these studies have predominantly focused on combined treatment. The present prospective clinical study aimed to assess the long-term effects and safety of high-dose IVMP therapy in thyroid-associated ophthalmopathy (TAO), as well as the significance of thyrotropin receptor antibody (TRAb) and soluble intercellular adhesion molecule-l (sICAM-1) during IVMP therapy. A total of 58 patients with TAO were treated with high-dose IVMP therapy, and their clinical characteristics and indices were recorded before, during and after therapy, with a 12–57 month (mean, 28.4 months) follow-up. Before treatment and on the second day after each IVMP therapy, serum TRAb and sICAM-1 levels were evaluated in 23 patients with TAO via a competitive radioimmunoassay and enzyme-linked immunosorbent assay, respectively. The results of the present study demonstrated that the symptoms of eyelid swelling, ophthalmodynia, photophobia, lacrimation and diplopia, and visual acuity, ocular motility, proptosis and clinical activity score (CAS) indices were all significantly improved after IVMP therapy. In addition, analysis of covariance demonstrated that alterations in the levels of serum TRAb during the course of treatment were associated with CAS of TAO, whereas the change in serum sICAM-1 was not. In conclusion, high-dose IVMP therapy is an effective, safe, stable and well-tolerated treatment for TAO, which is associated with rare, minor adverse effects. Furthermore, serum TRAb levels are correlated with the CAS of TAO and may serve as a predictor of the response to methylprednisolone therapy.

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Optic Neuropathy Following Orbital Irradiation for Graves’ Ophthalmopathy: A Case Report and Literature Review

Cited by 8 publications

References 15 publications

Treatment and prophylaxis of radiation optic neuropathy: A systematic review and meta-analysis

Treatment and prophylaxis of radiation optic neuropathy: A systematic review and meta-analysis

Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: A multicenter study

Short and long-term effects of high-dose intravenous methylprednisolone pulse therapy on thyroid-associated ophthalmopathy

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