Topical Treatment of Elevated Intraocular Pressure in Patients with Graves' Orbitopathy.

Magdalena Gumińska,Janusz Śmigielski,Roman Goś,Michał S Nowak

doi:10.3390/ijerph17249331

Abstract

Purpose: In this study, we evaluated the efficacy of topical hypotensive treatment and/or systemic corticosteroids therapy in patients with elevated intraocular pressure and Graves’ orbitopathy (GO). Methods: We included 172 eyes in 86 individuals with duration of GO ≥ 3 months, intraocular pressure in either eye ≥ 25.0 mmHg, and GO ranked ≥ 3 at least in one eye in modified CAS form. The study subjects were divided into three treatment subgroups: subgroup I was administered latanoprost once a day; subgroup II was administered a combined preparation of brimonidine and timolol BID; subgroup III was the control group, not receiving any topical hypotensive treatment. All the study participants received systemic treatment, intravenous corticosteroid therapy at the same dose, according to the European Group of Graves’ Orbitopathy (EUGOGO) guideline. Results: On the final visit, the mean IOP value was significantly lower in all treatment subgroups compared to the initial values. In both subgroups receiving topical treatment, the IOP reduction was higher than in the control group receiving systemic corticosteroids only. However, the latanoprost eye drops decreased intraocular pressure more effectively than drops containing brimonidine and timolol. Conclusion: Topical ocular hypotensive treatment is effective in reducing intraocular pressure in GO and decreases intraocular pressure more effectively than systemic corticosteroid therapy alone.

Highlights

Thyroid-associated orbitopathy, called Graves’ orbitopathy (GO), is an autoimmune, inflammatory disease of the orbital tissue
The aim of the present study was the evaluation of the efficacy of elevated intraocular pressure (IOP) treatment with the use of topical therapy with a prostaglandin-group drug and a complex drug, being a combination of a α2-mimetic and a β-blocker, and/or systemic corticosteroids therapy applied according to the European Group of Graves’ Orbitopathy (EUGOGO) guidelines in patients with orbitopathy in the course of Graves’ disease
Statistical analyses revealed that our three subgroups did not vary significantly in sex (χ2 test p = 0.760)

Summary

Introduction

Thyroid-associated orbitopathy, called Graves’ orbitopathy (GO), is an autoimmune, inflammatory disease of the orbital tissue. It is caused by autoantibodies against the thyrotropin receptor on endothelial cells of the thyroid follicles and against a subpopulation of orbital fibroblasts. It occurs in about 25–50% of patients with Graves’ disease (GD) [1,2,3,4,5]. It is estimated that elevated intraocular pressure (IOP) in the course of GO affects 3.7–24% of patients. In clinical practice, persisting increases in IOP, despite general treatment, are often observed [1,6,7,8,9,10,11]

Objectives

Methods

Results

Discussion

Conclusion