Evaluasi 97 Pasien Oftalmopati Graves’ Selama 3 Tahun Menggunakan Algoritma Eugogo dan Konsensus Nasional
Article Sidebar
-
Graves’ Ophthalmopathy, EUGOGO, CAS
Abstract
Introduction and Objective: Graves’ ophthalmopathy (GO) is an autoimmune disorder of the orbit that is closely associated with Graves’ diseases. Various classification system was proposed to evaluate clinical findings in GO. As controversy exists in assessment and management of GO there is a need to evaluate and improve diagnostic criteria using practical guideline.
Methods: We retrospectively reviewed Graves’ ophthalmopathy patients admitted between 2016 – 2018 to neuro-ophthalmology clinic. Clinical manifestation, the activity, severity and management of the disease were assessed using EUGOGO scale and Clinical Activity Score (CAS).
Result: A total of 97 GO patients included in the study. Male to female ratio is 1:2.7 which is highest in the age range of 30-50 years. The majority of patients have hyperthyroid status (41.2%) and bilateral clinical characteristics (77%). A total of 92 patients (94.8%) had visual acuity ?6/18. The most commonly reported clinical sign at the time of assessment is eyelid edema followed by conjunctival injection. Patients with mild EUGOGO status was entirely GO inactive while 5 active GO patients were of moderate-to-severe (4 patients) and 1 patient with sight-threatening GO. Patients with active GO received 1x500 mg of intravenous methylprednisolone for 3 days every week for 4 cycles where at the follow-up there was a significant decrease in CAS score by an average of 3-4 points.
Conclusion: The EUGOGO classification system provides diagnostic guidance and appropriate management algorithms for GO patients. Administration of high-dose intravenous methylprednisolone in active GO is still the first choice of therapy.
Full text article
References
Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 2008;158(3):273-85.
Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC. Graves’ ophthalmopathy: VISA versus EUGOGO classification, assessment, and management. J Ophthalmol. 2015;2015.
Ackuaku-Dogbe EM, Akpalu J, Abaidoo B. Epidemiology and clinical features of thyroid-associated orbitopathy in Accra. Middle East Afr J Ophthalmol. 2017;24(4):183.
Patricia AG, Nusanti S, Sidik M. Karakteristik Klinis dan Evaluasi Hasil Pengobatan Pasien Oftalmopati Graves di Divisi Neuro Oftalmologi Rumah Sakit Cipto Mangunkusumo Periode Januari 2013 - Desember 2014. [Penelitian Deskriptif]. In press 2015.
Mourits M, Koornneef L, Wiersinga W, Prummel M, Berghout A, Van Der Gaag R. Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach. Br J Ophthalmol. 1989;73(8):639-44.
Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly G, Marcocci C, et al. European Group on Graves’ Orbitopathy (EUGOGO): The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J. 2016;5(1):9-26.
Perros P, Neoh C, Dickinson J. Thyroid eye disease. BMJ. 2009;338:b560.
Bhatti MT, Dutton JJ. Thyroid eye disease: therapy in the active phase. J Neuroophthalmol. 2014;34(2):186-97.
Subekti I, Soewondo P, Soebardi S, Darmowidjojo B, Harbuwono DS, Purnamasari D, et al. Practical Guidelines Management of Graves Ophthalmopathy. Acta Med Indones - Indones J Intern Med. 2019;51(4):364-71.
Khong JJ, Finch S, De Silva C, Rylander S, Craig JE, Selva D, et al. Risk Factors for Graves' Orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) Study. J Clin Endocrinol Metab. 2016;101(7):2711-20.
R A. Karakteristik dan Derajat Keparahan Oftalmopati Graves di Divisi
Neuro Oftalmologi Departemen Mata RSCM periode 2001-2003. [Penelitian Deskriptif]. In press 2003.
Wiersinga WM, Kahaly GJ. Graves' Orbitopathy: A Multidisciplinary Approach-Questions and Answers. 3rd ed. Karger Medical and Scientific Publishers; 2017.
Tanda M, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed Graves' hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013;98(4):1443-9.
Perros P, Hegedüs L, Bartalena L, Marcocci C, Kahaly GJ, Baldeschi L, et al. Graves’ orbitopathy as a rare disease in Europe: a European Group on Graves’ Orbitopathy (EUGOGO) position statement. Orphanet J Rare Dis. 2017;12(1):72.
?ahl? E, Gündüz K. Thyroid-associated ophthalmopathy. Turk J Ophthalmol. 2017;47(2):94.
Wiersinga W, Perros P, Kahaly G, Mourits M, Baldeschi L, Boboridis K, et al. Clinical assessment of patients with Graves’ orbitopathy: the European Group on Graves’ Orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol. 2006;155(3):387-9.
Nair A, Desai S. An Algorithmic Approach in The Diagnosis and Management of Thyroid Eye Disease. J Clin Ophthalmol Res. 2015;3(2):113-9.
McAlinden C. An Overview of Thyroid Eye Disease. J Eye Vision. 2014;1(1):9.
Salvi M, Berchner-Pfannschmidt U, Ludgate M. Graves' Orbitopathy: Pathogenesis. Karger Publishers; 2017. p. 41-60.
Tu X, Dong Y, Zhang H, Su Q. Corticosteroids for Graves’ Ophthalmopathy: Systematic Review and Meta-Analysis. BioMed Res Int. 2018;2018.
Stiebel-Kalish H, Robenshtok E, Hasanreisoglu M, Ezrachi D, Shimon I, Leibovici L. Treatment Modalities for Graves’ Ophthalmopathy: Systematic Review and Metaanalysis. J Clin Endocrinol Metab. 2009;94(8):2708-16.
Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.