Effect Of Steroid Pulse Therapy Research Articles

Effect of Steroid Pulse Therapy on Ethambutol-induced Optic Neuropathy

Purpose: This study investigated the effects of high-dose steroid injections for ethambutol-induced optic neuropathy.Methods: A retrospective study examined 13 patients diagnosed with ethambutol-induced optic neuropathy at Wonju Severance Christian Hospital from December 2016 to November 2020. Methylprednisolone was injected at 1,000 mg/day for 3 days. The patients were evaluated before treatment; immediately after it; and at 1, 6, and 12 months. Visual acuity and visual fields were tested (Humphrey Field Analyzer, Carl Zeiss Meditec, Dublin, CA, USA) and the visual field index (VFI) and mean deviation (MD) were recorded.Results: We analyzed 26 eyes of 13 patients (6 males, 7 females; average age 68.7 years). Immediately after treatment, there was no significant improvement in visual acuity, but the VFI improved by 10% or more in 11 eyes and MD improved by 2 dB or more in 16 eyes. After the end of treatment, 13 of 26 eyes showed improved visual acuity of two lines or more in the Snellen table; VFI improved by more than 10% in 16 eyes and MD b y 2 dB or more in 20 eyes. The average differences in the final VFI and MD were 25.96 (standard deviation [SD] = 29.33) and 7.29 (SD = 7.09), respectively.Conclusions: When patients with ethambutol-induced optic neuropathy were treated with high-dose steroid injections, 60% (16/26) showed visual field improvement immediately after treatment and 77% (20/26) ultimately showed improvement. This suggests that steroids have a therapeutic effect in patients with optic neuropathy caused by ethambutol. Further studies are needed.

The effect of steroid pulse therapy for the reduction of acute rejection episode in subclinical borderline changes: an open-label, randomized clinical trial

The effect of steroid pulse therapy for the reduction of acute rejection episode in subclinical borderline changes: an open-label, randomized clinical trial

Efficacy of steroid pulse therapy for miliary tuberculosis complicated by acute respiratory distress syndrome

IntroductionAcute respiratory distress syndrome (ARDS) is considered a poor prognostic factor for miliary tuberculosis (MTB), but little is known about the effectiveness of steroid pulse therapy for MTB complicated by ARDS. Patients and methodsMedical records were used to retrospectively investigate the prognosis and clinical information of 13 patients diagnosed with MTB complicated by ARDS among 68 patients diagnosed with MTB at our hospital between January 1994 and October 2016. None of the patients had multidrug resistant tuberculosis (TB). MTB was diagnosed by 1 radiologist and 2 respiratory physicians based on the observation of randomly distributed, uniformly sized diffuse bilateral nodules on chest computed tomography and the detection of mycobacterium TB from clinical specimens. ARDS was diagnosed based on the Berlin definition of ARDS. The effect of steroid pulse therapy on death within 3 months of hospitalization was examined using Cox proportional hazards models. Variables were selected by the stepwise method (variable reduction method). ResultsSix of 8 patients with MTB complicated by ARDS were alive 3 months after hospitalization in the steroid pulse therapy group, whereas only 1 of 5 patients was alive in the non-steroid pulse therapy group. Analysis of factors related to the survival of patients with MTB complicated by ARDS revealed that steroid pulse therapy was the strong prognostic factor (hazard ratio = 0.136 (95 % CI: 0.023–0.815)). ConclusionOur findings suggest that steroid pulse therapy improves the short-term prognosis of patients with MTB complicated by ARDS.

Clinical and histological characterization of transient dermal pain triggered by sweating stimuli

BackgroundTingling dermal pain triggered by sweating impairs the lives of patients with cholinergic urticaria and generalized anhidrosis. However, dermal pain evoked by sweating stimuli has been under investigated. MethodsTo clarify characteristics of tingling dermal pain on sweating, we retrospectively evaluated clinical and histopathological manifestations in 30 patients having the main problem of dermal pain on sweating, and the efficacy of treatments. ResultsDermal pain upon sweating affected mostly young males. It accompanied eruptions upon sweating and/or hypohidrosis in 24 patients, while 6 patients had dermal pain independently of hypohidrosis or eruptions. Dermal pain appeared immediately upon exposure to sweating stimuli, and disappeared within mostly 30 or 10 min. Hypohidrosis was not necessarily generalized but localized or absent. Histological analysis revealed that dermal pain could occur even without morphological changes and inflammation of sweat glands. Hypersensitivity to sweat contents was found only in 26% of patients. Sweat histamine and increase of plasma histamine after thermal induction in patients were significantly higher than those in healthy subjects. Effectiveness of steroid pulse therapy was demonstrated for dermal pain with hypohidrosis. Medications acting on nervous systems and regular sweat-inducing activities for promoting perspiration were also effective. ConclusionsShort-lasting tingling dermal pain appears immediately upon exposure to sweating stimuli, regardless of developing eruptions and/or presence of hypohidrosis, but possibly in association with sweat and plasma histamine.

The effect of steroid pulse therapy for the reduction of acute rejection episode in subclinical borderline changes: an open-label, randomized clinical trial

The effect of steroid pulse therapy for the reduction of acute rejection episode in subclinical borderline changes: an open-label, randomized clinical trial

Meta-analysis of the Effectiveness of Steroid Pulse Therapy in Treating Patients with Spinal Cord Injury

Background: High-dose steroid injection therapy is effective in reducing anti-inflammation and edema and is often used to treat patients with acute spinal cord injury. To evaluate the effectiveness of steroid pulse therapy and identify the factors that affect its effectiveness in patients with acute traumatic spinal cord injury. Methods: A comprehensive literature search of the databases Pubmed, Medline, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL was performed on July 31, 2019, with no language and time limits. For analysis, studies conducted within the last 10 years were included to reflect on the recent trend. Results: A total of 3 randomized controlled trials and 5 observational studies with 2418 patients were included in this meta-analysis. High-dose steroid injection therapy was found to have a high effect on patients with acute spinal cord injury. The following factors had a strong influence on the effectiveness of high-dose steroid treatment in patients with acute spinal cord injuries: injury, onset ASIA, onset neurological assessment scales, time to start treatment after injury, age, BMI, and gender. Conclusion: It is necessary to accurately assess the scope of spinal injury in the early stages and actively provide nursing interventions to identify and mediate factors affecting the treatment effect.

Prognosis after steroid pulse therapy and seasonal effect in acquired idiopathic generalized anhidrosis.

Acquired idiopathic generalized anhidrosis is a rare disease with unknown etiology. Sudden loss of sweating function adversely affects young patients’ quality of life. Although systemic corticosteroid therapy is the most frequently reported treatment for the disease, its effectiveness is controversial because of the risk of recurrence. To assist clinical decision‐making regarding whether to use steroids, we investigated the treatment responsiveness and recurrence rates in patients undergoing steroid pulse therapy and explored factors affecting these rates. We retrospectively collected data of 124 patients who received steroid pulse therapy to calculate the rate of responsiveness to the therapy. We also conducted a time‐to‐event analysis in a cohort of 57 patients who responded to steroid pulse therapy to estimate the recurrence rate after the therapy. As a result, the response and recurrence rates were 73% and 48%, respectively. Recurrence occurred within 1 year in most patients. The overall effectiveness of steroid pulse therapy was estimated to be 57% considering the recurrence rate. A delay from onset to treatment and younger age appeared to be negative factors for effectiveness. Moreover, we found a significant seasonal effect on both treatment and recurrence: autumn was the worst season for acquired idiopathic generalized anhidrosis in Japan. Our study revealed that steroid pulse therapy can be expected to be effective in half of treated patients. We recommend starting the therapy promptly after the diagnosis; however, it is also worth considering the season for treatment planning.

Evaluation of medical and surgical decompression in patients with dysthyroid optic neuropathy

PurposeTo evaluate the effectiveness of steroid-pulse therapy and three-wall orbital decompression in patients with dysthyroid optic neuropathy (DON).MethodsTwenty-five patients (46 eyes) with a diagnosis of DON between 2008 and 2015 were included in the study. The first group (7 patients, 16 eyes) consisted of patients with a steroid-pulse treatment only and the second group (18 patients, 30 eyes) included patients with medical and surgical decompression.ResultsTwenty patients were female; five patients were male. After the diagnosis of DON, all patients were treated with steroid-pulse treatment (intravenous 500 mg prednisolon twice/week for 4 weeks, 250 mg twice/week for 2 weeks) as a first-line treatment (medical decompression). In 30 eyes (18 patients) out of 46 eyes, (25 patients) an orbital decompression was needed to preserve the optic nerve function. In those therapy-resistant cases (surgical decompression group), the orbital decompression led to statistically significant improvements in best-corrected visual acuity (BCVA), protan and tritan value of the color vision (p = 0.007, p < 0.0001, p = 0.019, respectively, comparison of first visit to last visit).ConclusionAccording to our data, the mild cases of DON with better initial visual acuity (in our case series mean: 0.3 logMAR) seem to respond well to steroid treatment. However, therapy-resistant cases with an impaired initial BCVA (in our case series, mean: 0.6 logMAR) seem to need the surgery to preserve the optic nerve function. In conclusion, this retrospective study confirms the effectiveness of surgical decompression in therapy-resistant cases of DON.

Plasma exchange: an effective add-on treatment of optic neuritis in neuromyelitis optica spectrum disorders.

To evaluate the efficiency of plasma exchange (PE) add-on on optic neuritis (ON) in neuromyelitis optica spectrum disorders (NMOSD). Our ambispective, nonrandomized study was performed in Southwest Hospital, Southwest Eye Hospital, Army Medical University. We studied 31 consecutive NMOSD patients characterized by ON and hospitalized from September 2015 to May 2018. Their clinical features were assessed, and efficiency of PE add-on treatment in ON of NMOSD was evaluated. Correlation was assessed between the effect of steroid pulse therapy (SPT) and the number of ON episodes in NMOSD. All 31 NMOSD patients accepted SPT; 15 patients of them accepted SPT and PE add-on. In these 15 patients, after PE add-on treatment, the patients' visual acuity was further significantly improved (P = 0.000, N = 23), including 3 no light perception (NLP) patients. After the treatment, the visual function recovered quickly in the first 2months and then gradually slowed down; the visual function remained stable about 6months later. The correlation coefficient between visual acuity improvement of SPT and the number of ON episodes was - 0.311 (P = 0.030, N = 49). One clinical feature of NMOSD can be repeated vision impairment. In NMOSD patients characterized by ON, efficacy of SPT is limited as the number of episodes increased, and PE add-on is more effective. Even though the visual acuity of NMOSD patients decreases to NLP during episodes, there is still a chance to restore vision by PE add-on treatment.

Effect of steroid pulse therapy on post-transplant immunoglobulin A nephropathy.

Recent studies have suggested that patients with post-transplant immunoglobulin A nephropathy have poor graft survival. There is limited research on the therapeutic effectiveness for post-transplant immunoglobulin A nephropathy, especially steroid pulse therapy. The present study evaluated the efficacy of steroid pulse therapy on post-transplant immunoglobulin A nephropathy. We retrospectively analyzed patients diagnosed with de novo or recurrent immunoglobulin A nephropathy at Kyushu University Hospital between January 2013 and August 2015. Patients with moderate proteinuria (≥0.5 g/g creatinine) and/or cellular or fibrocellular crescents on a graft biopsy were treated with steroid pulse therapy. Steroid pulse therapy was 500 mg/day for 3 days in weeks 1 and 2, followed by 20 mg of oral prednisolone that was tapered after 6 months. Patients were followed for 2 years, and the estimated glomerular filtration rate, urinary findings, and adverse events were recorded. Seven patients received steroid pulse therapy. The mean duration after kidney transplantation was 6.6 ± 4.7 years. After 2 years of treatment, 85.7% of patients reached complete remission of proteinuria, urinary protein excretion declined (0.82 ± 0.51 to 0.26 ± 0.22 g/g creatinine, P = 0.007), and the estimated glomerular filtration rate was maintained (48.7 ± 12.8 to 47.4 ± 14.0 mL/min per 1.73 m2 , P = 0.98). Adverse events were observed in one patient who developed herpes zoster infection. Steroid pulse therapy for post-transplant immunoglobulin A nephropathy effectively reduces proteinuria over 2 years. However, comparison of steroid pulse therapy and other regimens with a high-quality design is required.

Metastatic Thymoma-Associated Myasthenia Gravis: Favorable Response to Steroid Pulse Therapy Plus Immunosuppressive Agent.

BackgroundOur study retrospectively reviewed the therapeutic effect of steroid pulse therapy in combination with an immunosuppressive agent in myasthenia gravis (MG) patients with metastatic thymoma.Material/MethodsMG patients with metastatic thymoma that underwent methylprednisolone pulse therapy plus cyclophosphamide were retrospectively analyzed. Patients initially received methylprednisolone pulse therapy followed by oral methylprednisolone. Cyclophosphamide was prescribed simultaneously at the beginning of treatment. Clinical outcomes, including therapeutic efficacy and adverse effects of MG and thymoma, were assessed.ResultsTwelve patients were recruited. According to histological classification, 4 cases were type B2 thymoma, 3 were type B3, 2 were type B1, and 1 was type AB. After combined treatment for 15 days, both the thymoma and MG responded dramatically to high-dose methylprednisolone plus cyclophosphamide. The symptoms of MG were improved in all patients, with marked improvement in 6 patients and basic remission in 4. Interestingly, complete remission of thymoma was achieved in 5 patients and partial remission in 7 patients. Myasthenic crisis was observed in 1 patient and was relieved after intubation and ventilation. Adverse reactions were observed in 7 patients (58.3%), most commonly infections, and all were resolved without discontinuation of therapy. During the follow-up, all patients were stabilized except for 1 with pleural metastasis who received further treatment and another 1 who died from myasthenic crisis.ConclusionsThe present study in a series of MG patients with metastatic thymoma indicated that steroid pulse therapy in combination with immunosuppressive agents was an effective and well-tolerated for treatment of both metastatic thymoma and MG. Glucocorticoid pulse therapy plus immunosuppressive agents should therefore be considered in MG patients with metastatic thymoma.

The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients: a randomized crossover observational clinical study

Hyperglycemia is a common, but not well-characterized side effect of glucocorticoid treatment. To study the effect of pulse dexamethasone treatment on carbohydrate metabolism among multiple myeloma patients. A randomized crossover observational study in a teaching hospital with nine myeloma patients (one male, two with known type 2 diabetes (KDM), mean age 69.0 ± 6.7 years) were investigated using a standard 75 g Oral Glucose Tolerance Test (patients without KDM) and a 3-day continuous glucose monitoring (CGM--all patients) during and between dexamethasone cycles. During dexamethasone treatment patients had elevated 2-h postload glucose (12.8 ± 4.7 vs. 8.7 ± 3.2 mmol/L, P = 0.024) but similar fasting glucose (6.3 ± 1.4 vs. 5.1 ± 0.5 mmol/L, P = 0.112). Estimated hourly mean interstitial glucose values based on linear mixed models showed an increase of 0.03 [SE 0.01] mmol/L per hour from 5.0 [0.4] in patients without KDM and followed a quadratic curve from 5.0 [0.4] mmol/L at midnight to 7.5 [0.5] mmol/L at 12:00 h in patients with KDM during control periods. During dexamethasone treatment glucose was similar to control periods between 02:00 and 12:00 h in the non-KDM group, where they followed a cubic trajectory from 5.3 [0.4] mmol/L at 04:00 h to 7.3 [0.4] mmol/L at 18:00 h. In contrast, interstitial glucose was increased by at least 7.9 [0.3] mmol/L throughout the day in KDM patients during dexamethasone treatment and increased from 13.6 [0.5] mmol/L at midnight to 17.5 [0.5] mmol/L at 17:00 h. During pulse steroid therapy of myeloma patients without KDM afternoon and evening glucose measurements may be the optimal tools to characterize glucose metabolism.

HEART's Original [症例] ステロイドパルス療法が著効し心機能の改善を認めた心サルコイドーシスの1例

HEART's Original [症例] ステロイドパルス療法が著効し心機能の改善を認めた心サルコイドーシスの1例

A case of cardiac and plumonary sarcoidosis showing acute exacerbation : the effect of steroid pulse therapy

A case of cardiac and plumonary sarcoidosis showing acute exacerbation : the effect of steroid pulse therapy

Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy

Pozzi et al. reported the effectiveness of steroid pulse therapy (Pozzi's regimen) in IgA nephropathy (IgAN). The present study was performed to clarify the predictive factors for IgAN patients treated with Pozzi's regimen. One hundred nine IgAN patients treated by Pozzi's regimen were observed for up to 112.6 (median 39.7) months, and remission of proteinuria (PR) and disappearance of urinary abnormalities [complete remission (CR)] after Pozzi's regimen were analyzed. Predictive factors for the glomerular filtration rate (GFR) slopes for up to 5years were analyzed among 81 patients who were observed for at least 2years. The outcome of a 50% increase in sCr was compared between the CR and non-CR groups within 2years. Cumulative PR and CR rates increased rapidly until 2years (54.5 and 46.8% at 2years), and then slowly but steadily up to 6years (72.8 and 66.4% at 6years). Baseline characteristics of the CR and non-CR groups within 2years were similar except for proteinuria. GFR slope was steeper in the non-CR group than in the CR group (-2.44±5.12 vs. -0.32±3.34ml/min/1.73m(2)/year). On multivariate analysis, sex and CR within 2years were associated with GFR slope. Kaplan-Meier analysis demonstrated a better survival rate in CR group patients without a 50% increase in sCr (p=0.024). Among IgAN patients treated with Pozzi's regimen, CR within 2years predicts a good prognosis.

Usefulness of anterior chamber depth measurement for efficacy assessment of steroid pulse therapy in patients with Vogt-Koyanagi-Harada disease

To clarify the usefulness of measuring anterior chamber depth by the IOLMaster for early-stage assessment of the therapeutic effect of steroid pulse therapy in patients with Vogt-Koyanagi-Harada (VKH) syndrome with active uveitis. Seven patients with VKH syndrome (three men and four women) participated in the study (14 eyes). All patients had exudative retinal detachment in addition to iritis, and received steroid pulse therapy: infusion of methylprednisolone (1000 mg × 3 days) followed by tapering oral administration of prednisolone (40, 30, 20, 15, 10, and 5 mg/day) over a week. Corrected visual acuity, manifest spherical equivalent, anterior chamber flare, axial length, and anterior chamber depth were measured before and after the pulse therapy. Anterior chamber flare was measured using a laser flare-cell meter, and axial length and anterior chamber depth were measured using the IOLMaster. After 1 week of steroid pulse therapy, anterior chamber depth significantly increased from the initial value of 2.94 ± 0.34 mm to 3.12 ± 0.38 mm (Wilcoxon signed-rank test, P = 0.002). After 1 month of steroid pulse therapy, significant changes were observed in corrected visual acuity (P = 0.01), manifest spherical equivalent (P = 0.002), anterior chamber flare (P = 0.03), axial length (P = 0.02), and anterior chamber depth (P = 0.002). Measurement of anterior chamber depth using the IOLMaster is useful for early-stage assessment of the effect of steroid pulse therapy in patients with VKH syndrome who develop active uveitis. Change in anterior chamber depth is the most sensitive indicator of inflammatory activity in patients with this syndrome.

Clinical effectiveness of steroid pulse therapy combined with tonsillectomy in patients with immunoglobulin A nephropathy presenting glomerular haematuria and minimal proteinuria

The effectiveness of steroid pulse therapy combined with tonsillectomy (ST) has been shown in immunoglobulin A nephropathy (IgAN) patients with moderate or severe urinary abnormalities. The present study aimed to clarify whether the effectiveness may be extrapolated to IgAN with minor urinary abnormalities, and whether the effectiveness may depend on the histological severity with minor urinary abnormalities. Data on 388 IgAN patients diagnosed by renal biopsies between 1987 and 2000 in Sendai Shakaihoken Hospital, who presented glomerular haematuria and minimal proteinuria (<or=0.5 g/day) at baseline, were analyzed. Cox regression was used to examine associations between baseline use of ST and subsequent clinical remission (CR), defined as negative proteinuria by dipstick and urinary erythrocytes of less than 1/high-power field. The instrumental variable method was also used to overcome confounding by treatment indication. During a median follow up of 24 months, we observed 170 CR cases. Patients receiving ST were younger and showed a better case-mix profile. Patients with ST had a significantly higher rate of CR than patients without tonsillectomy or steroid pulse in an unadjusted (hazard ratio (HR) = 5.51, 95% confidence interval (CI) = 3.33-9.12, P < 0.001) or adjusted Cox model (HR = 4.65, 95% CI = 2.43-8.88, P < 0.001). Less severe histological findings were substantially associated with higher CR rate in ST group. Adjusting for confounding by treatment indication showed an attenuated but still significant effect of ST (HR = 3.10, 95% CI = 2.02-4.77, P < 0.001). ST significantly increased the probability of CR in IgAN patients with glomerular haematuria and minimal proteinuria, and it was more effective in those with less severe histological findings.

High Regression Rate of Coronary Aneurysms Developed in Patients with Immune Globulin-Resistant Kawasaki Disease Treated with Steroid Pulse Therapy

Kawasaki disease is an acute vasculitis syndrome of unknown etiology that mainly affects small and medium-size arteries, particularly the coronary artery. Coronary artery lesions may develop into aneurismal formation and thrombotic occlusion, and progress to ischemic heart disease. The aim of the present study was to investigate the effect of steroid pulse therapy following intravenous immune globulin (IVIG) treatment on the regression rate of aneurysms in Kawasaki disease. Among 93 sequential patients referred to us, because of coronary artery lesions in the acute phase, we found 23 aneurysms in 12 patients during the period from January 1997 to January 2008. We divided them into two groups: a non-steroid group, 7 patients (13 aneurysms) treated with single or multiple IVIG but no steroid pulse therapy; and a steroid group, 5 patients (10 aneurysms) treated with multiple IVIG followed by steroid pulse therapy. We compared the regression rate of the aneurysms between the two groups, retrospectively. The regression rates of the aneurysms in the steroid group were significantly higher than those in the non-steroid group when we analyzed 1) all aneurysms (p = 0.007), 2) giant aneurysms (aneurismal diameter was 4 or more x normal, or > 8 mm) (p = 0.018), and 3) aneurysms in IVIG-resistant patients who were resistant to initial IVIG therapy (p = 0.035). All aneurysms, including the giant aneurysms in the steroid group, regressed, and the regression rate of the aneurysms in the non-steroid group was about 46%(6/13). Steroid pulse therapy may be beneficial for IVIG-resistant patients. Our data suggest that steroid pulse therapy may lead to regression of aneurysms.

Improved Oxygenation by Steroid Pulse Therapy in Early-Phase Acute Respiratory Distress Syndrome

Objective and Background: Although short-duration, high-dose glucocorticoid therapy is reportedly ineffective for early-phase acute respiratory distress syndrome (ARDS), steroid pulse therapy is often used in Japan for life-threatening cases because of its beneficial effects on oxygenation. Thus, we evaluated the effect of steroid pulse therapy on oxygenation for early-phase ARDS. Method: Cases of early-phase ARDS treated with steroid pulse therapy in intensive care units of four critical care medical centers in Japan from 2000 to 2003 were investigated. Clinical course and serial changes in PaO2/FIO2 ratio were evaluated. Results: Twenty-nine patients received methylprednisolone 1 g/day for 3 days; 20 patients subsequently received prolonged methylprednisolone treatment. Causes of ARDS were pneumonia (n=23), extrapulmonary sepsis (n=4) and other factors (n=2). The overall mortality rate was 24.1%. PaO2/FIO2 ratios improved significantly after initiation of steroid pulse therapy, in comparison to pretreatment values (day 0: 119.8 ± 30.6, day 1: 172.1 ± 63.7*, day 2: 196.4 ± 90.0*, day 3: 218.4 ± 92.0*, mean ± SD, *p < 0.05 vs. day 0). Significant improvement in oxygenation was observed in both survivors and non-survivors, but the PaO2/FIO2 ratio in non-survivors subsequently deteriorated. In seven patients with life-threatening hypoxemia (PaO2/FIO2 ratio < 100 at day 0), oxygenation improved significantly after pulse treatment; five of these patients survived. Conclusions: Three day steroid pulse therapy can improve oxygenation in patients with progressive ARDS even in the early phase. Steroid therapy for early-phase ARDS should be reconsidered.

Effect of steroid pulse therapy with and without orbital radiotherapy on Graves’ ophthalmopathy

PurposeTo report the effect of high-dose intravenous corticosteroid pulse therapy with and without orbital radiotherapy on Graves’ ophthalmopathy. DesignNonrandomized clinical trial. MethodsWe selected 39 Japanese patients (age range, 22–64 years; mean, 48 years; 31 women, 8 men) who had active Graves’ ophthalmopathy among 195 consecutive patients. In the first 20 patients, high-dose intravenous methylprednisolone pulse therapy (1 g per day for 3 successive days, repeated 3 times within 3 weeks) followed by 24-Gy orbital radiotherapy was performed. In the other 19 of the 39 patients, high-dose intravenous methylprednisolone pulse therapy without orbital radiotherapy was performed. Coronal computed tomography (CT) of the orbit and exophthalmometry were performed before the corticosteroid pulse therapy, and 1 and 6 months after the corticosteroid pulse therapy. The maximum coronal section area of the most hypertrophic rectus muscle in each eye was measured based on orbital CT imaging. ResultsClinical findings at study entry were not significantly different between the two groups. No significant difference was found in the maximum coronal section area of the most hypertrophic rectus muscle and the results of exophthalmometry measurements in both groups before the therapy. Extraocular muscle hypertrophy was significantly reduced 1 month and 6 months after the therapy (P < .01) in both groups. However, no beneficial therapeutic effect on proptosis was observed in either group at 1 month and 6 months after the therapy. No significant difference in the therapeutic effect on extraocular muscle hypertrophy and proptosis was found between the two groups. ConclusionsOrbital irradiation after corticosteroid pulse therapy had no beneficial therapeutic effects on rectus muscle hypertrophy or proptosis of active Graves’ ophthalmopathy during the 6-month follow-up period.