ABSTRACT
PURPOSE: To evaluate the safety and efficacy of oral steroids when combined with long-term oral azathioprine (AZA) and orbital radiotherapy in patients with active thyroid-related restrictive myopathy. METHODS: A total of 88 patients from adnexal outpatient clinics of Bristol Eye Hospital, UK, and 2nd Department of Ophthalmology at Aristotle University of Thessaloniki, Greece, were enrolled in a retrospective, twin-center study. All patients were diagnosed with active thyroid eye disease and concomitant restrictive myopathy. Treatment included oral AZA, low-dose steroids, and orbital radiotherapy (20 Gy). Clinical activity scores as well as orthoptic assessments were consistently evaluated. Clinical activity scores, improved levels of diplopia, and single muscle excursions were considered major criteria for treatment success. RESULTS: Clinical success was achieved in 54 (61.4%), 57 (64.8%), and 61 (69.3%) patients at 3-, 6-, and 12-month time points, respectively, after the initiation of the combined treatment. At 18 months following initiation of treatment, the percentage of treatment success reached 73.9% (n = 65). Nine patients developed AZA-related side effects. In 4 patients the drug had to be discontinued. CONCLUSIONS: Combined immunosuppression with orbital radiotherapy appears to reduce morbidity in patients with marked restrictive myopathy by improving major motility parameters such as diplopia and duction amplitude.
Subject(s)
Azathioprine/therapeutic use , Graves Ophthalmopathy/therapy , Immunosuppressive Agents/therapeutic use , Orbital Diseases/therapy , Radiotherapy , Adult , Aged , Azathioprine/adverse effects , Combined Modality Therapy , Dose Fractionation, Radiation , Female , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic use , Graves Ophthalmopathy/drug therapy , Graves Ophthalmopathy/radiotherapy , Humans , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Orbital Diseases/drug therapy , Orbital Diseases/radiotherapy , Particle Accelerators , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To evaluate the efficacy of self-retaining bicanaliculus stents when used as an adjunct to 3-snip punctoplasty in comparison with standard 3-snip procedure between fellow eyes. METHODS: Prospective, randomized, comparative study. Thirty-two eyes of 16 consecutive patients with acquired, nontraumatic stenosis of the proximal lacrimal duct were randomly distributed into 2 equal study groups. Lower punctal stenosis was a standard prerequisite. Group A (16 eyes) received a simple 3-snip punctoplasty, while group B (16 fellow eyes) underwent a modified 3-snip punctoplasty combined with insertion of self-retaining bicanaliculus stents. Duration of follow ups: 6 months. Anatomical, functional, and subjective parameters were evaluated. RESULTS: A statistically significant difference in anatomical success rates was observed in favor of group B (p = 0.011) 6 months postoperatively. Complete relief from epiphora was noted in 8 eyes of group B compared with 2 eyes of group A (p = 0.057). In regard to mixed (absolute and partial) functional success rates, group B exceeded with statistically significant difference (15 eyes group B vs. 6 eyes group A; p = 0.002). A nasolacrimal duct obstruction was subsequently diagnosed in 3 of the nonpatient eyes. Reintroduction of silicone tubes was required in 4 eyes of group B. CONCLUSIONS: The use of self-retaining bicanaliculus stents seems to improve anatomical, functional, and subjective scores when combined with standard 3-snip punctoplasty in patients with acquired upper lacrimal duct stenosis.
