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Conceição et al., from
the Federal University of Rio de Janeiro, Brazil, followed
fourteen patients (3 men, 11 women, ages between 14–71 yr.)
with TAO described as moderately active (10) or intensively
affected (4). All patients were treated with methylprednisolone
pulse therapy, while 10 patients were subsequently submitted to
external radiation therapy. The results of the therapeutic
procedures were analyzed under two variables: length of TAO
disease and tobacco users (smokers). It was concluded that the
more prolonged the duration of TAO, the worse the prognosis.
Moreover, heavy cigarette smokers had a very poor response to the
treatment. Both variables would act independently.
Serum cytokines concentrations were assayed during methylprednisolon pulse therapy of TAO by Farah et al. (Hospital IAMSPE, São Paulo, Brazil). The aim of this study was to evaluate the cytokines serum concentrations in euthyroid TAO patients treated with pulse therapy (10 g i.v., nine sessions of 60 minutes each). The clinical activity score (CAS) and retrobulbar eye muscle (REM) enlargement measured by ultrasonography were used in the patients follow-up. The serum TNFa, IL-6, IL-8, soluble IL-2R (sIL-2R ) and IL-1b concentrations were determined before and after each session by a sensitive ELISA assay (R&D System , USA) and compared with seven controls subjects (table 1). CAS and REM thickness at the end of the treatment were reduced in all patients. When compared with controls, TAO patients had elevated serum IL-6 (p<002) and IL-8 (p<0.01). Following treatment, IL-6 levels fell in all patients. IL-1b levels fell in four patients and IL-8 levels increased. No significant change was noted in serum levels of TNF-a and sIL-2R. In conclusion, IL-6l and IL-1b appear related to TAO clinical activity and this suggest that serum determinations of these cytokines may be useful in the evaluation of efficacy of imunosupressive therapy. Monteiro et al., from the University of São Paulo Medical School, São Paulo, Brazil, reported on the restricted orbital decompression technique in TAO. They employed partial removal of two (antral-ethmoidal) orbital walls. Fourteen patients (10 females) mean age 41.7 years, were submitted to 22 orbital decompressions. Three operations (2 patients) were performed in the congestive phase of the ophthalmopathy because of severe corneal ulceration. These patients were receiving corticosteroids combined with radiotheraphy and cyclofos-famide and these treatments were continued after surgery. Nineteen orbital walls were operated during the inactive phase of the ophthalmopathy in order to improve cosmetic and ocular discomfort. Operations were performed from a superior approach, using a conjunctival incision in 19 and a palpebral one in 3. The reduction of proptosis ranged from 1 to 6 mm. Mean reduction was 5.33 ± 0.27 mm in the patients operated in the acute phase and 3.68 ± 0.25 mm in those operated in the inactive phase of the ophthalmopathy. None developed diplopia as a result of the surgery. Surgical correction of pre-existing strabismus was performed in two patients and temporary blepharorraphy was associated with the decompression in the cases operated in the acute phase. Six patients were subsequently submitted to surgical correction of pre-existing lid retraction. In one patient inferior lid retraction worsened as a result of the lid incision. Transient anesthesia of the cheek was commonly observed but not permanent. The authors concluded that: antral-ethmoidal orbital decompression is efficient in reducing proptosis in patients with Graves’ ophthalmopathy and is associated with a very low incidence of complications. When combined with other treatment modalities it can be helpful in severe cases of TAO, even in the acute phase. Likewise, it is of benefit in the cosmetic rehabilitation of patients with residual proptosis. Conceição & Vaissman, Federal University of Rio de Janeiro, Brazil, called the attention to opportunistic infections in patients treated with pulse corticosteroid therapy for severe TAO. They observed extensive fungoid dermatitis in the gluteal region, and the presence of Herpes simplex lesions in the mouth and external genitalia. They concluded that aside from the well known adverse effects of methylprednisolone pulse therapy such as gastric irritation, induction of glucose intolerance and systemic hypertension, patients with TAO must be monitored for cutaneous infections. |
