Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy

Nicola Currò, Danila Covelli, Guia Vannucchi, Irene Campi, Giacinta Pirola, Simona Simonetta, Davide Dazzi, Claudio Guastella, Lorenzo Pignataro, Paolo Beck-Peccoz, Roberto Ratiglia, Mario Salvi

Research output: Contribution to journalArticle

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Abstract

Background: While pulsed intravenous methylprednisolone (iv-MP) has been shown to be effective and well tolerated in moderate to severe Graves' orbitopathy (GO), limited data are available on dysthyroid optic neuropathy (DON). The objective of this retrospective study was to investigate the efficacy of iv-MP in the treatment of DON and to seek parameters predictive of response. Methods: Twenty-four DON patients (40 eyes) treated with iv-MP from 2007 to 2012 were included in the study. Concurrent neurological or ophthalmologic diseases or signs of corneal exposure were considered as exclusion criteria. Iv-MP was administered daily for three consecutive days and repeated the following week. At six months, eyes not requiring surgery to preserve visual function were considered as responsive to treatment. Visual acuity, color sensitivity, visual field, and optic discs were analyzed at two and four weeks, and at 3, 6, and 12 months after treatment. Activity of GO was graded using a clinical activity score (CAS). Visual and clinical characteristics of the eyes responsive to iv-MP were studied by comparison to those of nonresponsive eyes. Results: At six months, 17 of 40 (42.5%) eyes had complete visual recovery and were spared from surgical decompression. At two weeks, visual acuity, color sensitivity, and visual field improved significantly in almost all eyes, but GO inactivated (CAS5; 40.2% sensitivity, 94.1% specificity) and severely altered visual field mean defect (cutoff ≤6.31dB; 73.9% sensitivity, 58.8% specificity) were associated with unresponsiveness to steroids. No major side effects were observed. Conclusions: High-dose iv-MP was effective in permanently restoring visual function in about 40% of the eyes treated. When successful, it generally induced inactivation of the orbital disease within two weeks and normalization of visual function within one month. The presence of optic disc swelling at diagnosis and persistent active disease at two weeks were good predictors of unresponsiveness to steroids.

Original languageEnglish
Pages (from-to)897-905
Number of pages9
JournalThyroid
Volume24
Issue number5
DOIs
Publication statusPublished - May 1 2014

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Optic Nerve Diseases
Methylprednisolone
Steroids
Visual Fields
Optic Disk
Therapeutics
Visual Acuity
Color
Orbital Diseases
Surgical Decompression
Sensitivity and Specificity
Retrospective Studies

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. / Currò, Nicola; Covelli, Danila; Vannucchi, Guia; Campi, Irene; Pirola, Giacinta; Simonetta, Simona; Dazzi, Davide; Guastella, Claudio; Pignataro, Lorenzo; Beck-Peccoz, Paolo; Ratiglia, Roberto; Salvi, Mario.

In: Thyroid, Vol. 24, No. 5, 01.05.2014, p. 897-905.

Research output: Contribution to journalArticle

Currò, N, Covelli, D, Vannucchi, G, Campi, I, Pirola, G, Simonetta, S, Dazzi, D, Guastella, C, Pignataro, L, Beck-Peccoz, P, Ratiglia, R & Salvi, M 2014, 'Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy', Thyroid, vol. 24, no. 5, pp. 897-905. https://doi.org/10.1089/thy.2013.0445
Currò, Nicola ; Covelli, Danila ; Vannucchi, Guia ; Campi, Irene ; Pirola, Giacinta ; Simonetta, Simona ; Dazzi, Davide ; Guastella, Claudio ; Pignataro, Lorenzo ; Beck-Peccoz, Paolo ; Ratiglia, Roberto ; Salvi, Mario. / Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. In: Thyroid. 2014 ; Vol. 24, No. 5. pp. 897-905.
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abstract = "Background: While pulsed intravenous methylprednisolone (iv-MP) has been shown to be effective and well tolerated in moderate to severe Graves' orbitopathy (GO), limited data are available on dysthyroid optic neuropathy (DON). The objective of this retrospective study was to investigate the efficacy of iv-MP in the treatment of DON and to seek parameters predictive of response. Methods: Twenty-four DON patients (40 eyes) treated with iv-MP from 2007 to 2012 were included in the study. Concurrent neurological or ophthalmologic diseases or signs of corneal exposure were considered as exclusion criteria. Iv-MP was administered daily for three consecutive days and repeated the following week. At six months, eyes not requiring surgery to preserve visual function were considered as responsive to treatment. Visual acuity, color sensitivity, visual field, and optic discs were analyzed at two and four weeks, and at 3, 6, and 12 months after treatment. Activity of GO was graded using a clinical activity score (CAS). Visual and clinical characteristics of the eyes responsive to iv-MP were studied by comparison to those of nonresponsive eyes. Results: At six months, 17 of 40 (42.5{\%}) eyes had complete visual recovery and were spared from surgical decompression. At two weeks, visual acuity, color sensitivity, and visual field improved significantly in almost all eyes, but GO inactivated (CAS5; 40.2{\%} sensitivity, 94.1{\%} specificity) and severely altered visual field mean defect (cutoff ≤6.31dB; 73.9{\%} sensitivity, 58.8{\%} specificity) were associated with unresponsiveness to steroids. No major side effects were observed. Conclusions: High-dose iv-MP was effective in permanently restoring visual function in about 40{\%} of the eyes treated. When successful, it generally induced inactivation of the orbital disease within two weeks and normalization of visual function within one month. The presence of optic disc swelling at diagnosis and persistent active disease at two weeks were good predictors of unresponsiveness to steroids.",
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AU - Pirola, Giacinta

AU - Simonetta, Simona

AU - Dazzi, Davide

AU - Guastella, Claudio

AU - Pignataro, Lorenzo

AU - Beck-Peccoz, Paolo

AU - Ratiglia, Roberto

AU - Salvi, Mario

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N2 - Background: While pulsed intravenous methylprednisolone (iv-MP) has been shown to be effective and well tolerated in moderate to severe Graves' orbitopathy (GO), limited data are available on dysthyroid optic neuropathy (DON). The objective of this retrospective study was to investigate the efficacy of iv-MP in the treatment of DON and to seek parameters predictive of response. Methods: Twenty-four DON patients (40 eyes) treated with iv-MP from 2007 to 2012 were included in the study. Concurrent neurological or ophthalmologic diseases or signs of corneal exposure were considered as exclusion criteria. Iv-MP was administered daily for three consecutive days and repeated the following week. At six months, eyes not requiring surgery to preserve visual function were considered as responsive to treatment. Visual acuity, color sensitivity, visual field, and optic discs were analyzed at two and four weeks, and at 3, 6, and 12 months after treatment. Activity of GO was graded using a clinical activity score (CAS). Visual and clinical characteristics of the eyes responsive to iv-MP were studied by comparison to those of nonresponsive eyes. Results: At six months, 17 of 40 (42.5%) eyes had complete visual recovery and were spared from surgical decompression. At two weeks, visual acuity, color sensitivity, and visual field improved significantly in almost all eyes, but GO inactivated (CAS5; 40.2% sensitivity, 94.1% specificity) and severely altered visual field mean defect (cutoff ≤6.31dB; 73.9% sensitivity, 58.8% specificity) were associated with unresponsiveness to steroids. No major side effects were observed. Conclusions: High-dose iv-MP was effective in permanently restoring visual function in about 40% of the eyes treated. When successful, it generally induced inactivation of the orbital disease within two weeks and normalization of visual function within one month. The presence of optic disc swelling at diagnosis and persistent active disease at two weeks were good predictors of unresponsiveness to steroids.

AB - Background: While pulsed intravenous methylprednisolone (iv-MP) has been shown to be effective and well tolerated in moderate to severe Graves' orbitopathy (GO), limited data are available on dysthyroid optic neuropathy (DON). The objective of this retrospective study was to investigate the efficacy of iv-MP in the treatment of DON and to seek parameters predictive of response. Methods: Twenty-four DON patients (40 eyes) treated with iv-MP from 2007 to 2012 were included in the study. Concurrent neurological or ophthalmologic diseases or signs of corneal exposure were considered as exclusion criteria. Iv-MP was administered daily for three consecutive days and repeated the following week. At six months, eyes not requiring surgery to preserve visual function were considered as responsive to treatment. Visual acuity, color sensitivity, visual field, and optic discs were analyzed at two and four weeks, and at 3, 6, and 12 months after treatment. Activity of GO was graded using a clinical activity score (CAS). Visual and clinical characteristics of the eyes responsive to iv-MP were studied by comparison to those of nonresponsive eyes. Results: At six months, 17 of 40 (42.5%) eyes had complete visual recovery and were spared from surgical decompression. At two weeks, visual acuity, color sensitivity, and visual field improved significantly in almost all eyes, but GO inactivated (CAS5; 40.2% sensitivity, 94.1% specificity) and severely altered visual field mean defect (cutoff ≤6.31dB; 73.9% sensitivity, 58.8% specificity) were associated with unresponsiveness to steroids. No major side effects were observed. Conclusions: High-dose iv-MP was effective in permanently restoring visual function in about 40% of the eyes treated. When successful, it generally induced inactivation of the orbital disease within two weeks and normalization of visual function within one month. The presence of optic disc swelling at diagnosis and persistent active disease at two weeks were good predictors of unresponsiveness to steroids.

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