Neuropatía óptica distiroidea como manifestación de orbitopatía de Graves / Dysthyroid optic neuropathy: report of one case

Dysthyroid optic neuropathy is an uncommon and severe form of presentation of Graves ophtalmopathy, caused by compression and elongation of the optic nerve. Use of high dose steroids is the treatment of choice. Decompressive surgery is reserved for refractory cases. We report a 41 years old female with a dysthyroid optic neuropathy that appeared 18 years after the diagnosis of Graves disease, manifested by a marked reduction in visual acuity. Orbit CAT scan did not show compression or elongation of optic nerve. She was treated with prednisone 60 mg per day, obtaining a complete remission after 19 days of treatment. After 90 days of follow up with low doses of steroids, the patient remains asymptomatic.

Tratamiento de la enfermedad ocular inflamatoria con glucocorticoides y pulsos de ciclofosfamida / Treatment of inflammatory ocular disease with glucocorticoids and cyclophosphamide pulses

The effectiveness, toxicity and prognosis factors influencing responses to cyclophosphamide (CP) iv pulses plus oral glucocorticosteroids (GC) in patients with GC-resistant ocular inflammatory diseases (OID) was evaluated in a cohort of 15 consecutive patients suffering from active, non-infectious OID refractory to oral GC. All patients underwent monthly evaluations with clinical, hematological, hepatic, renal and ophthalmologic tests. These included checking visual acuity and both anterior chamber and posterior segment inflammation. The overall effect evaluated by repeated measurements ANOVA demonstrated that after an average of 5 CP pulses 1-10, the group showed significant improvement regarding of visual aciuty and inflammation (p<0,000001). Amelioration was not sustained over time in patients with granulomatous iveitis. Patients with retinal vasculitis experienced rapid and sustained recovery. By the end of the follow-up period, 53 percent of the patients had improved, 20 percent remained stationary and 26 percent suffered visual acuity deterioration as compared with the baseline. No serious side effects were detected during treatment and follow-up. Conclusions: a combination of oral GC and iv CP pulses appears to be an effective way to treat patients suffering from noninfectious, non-granulomatous, GC-resistant OID