Retinal Microvascular Abnormalities in Patients Treated With External Radiation for Graves Ophthalmopathy

Abstract

Background: A prospective study was conducted to determine if external ionizing radiation could favorably influence the orbital manifestations of Graves ophthalmopathy. Diabetes and untreated systemic hypertension were exclusion criteria. Radiation was directed to the orbits of 42 affected patients using 0.2 rad (20 Gy) delivered in 10 doses of 0.02 rad (2 Gy). Patients were periodically examined during a 3-year interval.Objective: To report retinal microvascular abnormalities observed in our study cohort.Methods: Fundus findings documented with ophthalmoscopy, stereoscopic color photography, and stereoscopic fluorescein angiography prior to radiation were compared with similarly documented findings approximately 3 years following radiation.Results: Prior to orbital radiation, retinal microvascular abnormalities were identified in 2 patients. The abnormalities were present bilaterally in one patient and unilaterally in the other. During the course of the study, microvascular abnormalities developed de novo in the unaffected retina of the latter patient while the retinopathy in the fellow eye progressed. Retinal microvascular CLINICAL SCIENCES

Consensus Statement of the European Group on Graves' Orbitopathy (EUGOGO) on Management of Graves' Orbitopathy

“…Although cataracts can occur earlier after OR than naturally, they are easily treated by surgery. Retinal microvascular abnormalities have been detected in a minority of patients (79), mostly in those with concomitant severe hypertension or diabetic retinopathy, and these two comorbidities are considered absolute contraindications to OR (80,81). It is possible that diabetes, even in the absence of retinopathy, represents a risk factor for the development of retinal changes after OR (78), but the evidence is less clear (77).…”

A questionnaire survey on the management of Graves’ orbitopathy in Europe

“…A previous European questionnaire survey conducted in 1996 (2) showed a marked variation among thyroid experts across Europe in the treatment of GO, indicative of the lack of well-designed studies in this area. Since the collection of that data, a number of new pieces of evidence in this field has emerged including prospective randomised studies (3)(4)(5)(6)(7), studies on the effects of smoking on treatment outcomes, and studies addressing safety issues of medical treatments (8)(9)(10)(11).…”

Medical Treatment of Moderately Severe and Vision-Threatening Graves’ Orbitopathy

“…In a prospective study in 42 individuals with GO treated with 20 Gy external beam irradiation [ 60 ], de novo or aggravation of microvascular abnormalities were found in three patients. In another follow-up study [ 61 ], 245 patients were screened 10-20 years after having received either 20 Gy external beam irradiation or oral prednisone.…”