Posters

Antithymocyte globulin in Graves-Basedow orbitopathy

Poster Details

First Author: M.Sarnat-Kucharczyk POLAND

Co Author(s): E. Mrukwa-Kominek   J. Chudek                 

Abstract Details

Purpose:

The aim is to describe a case of one patient from the group of 6 people who were included in experimental intravenous treatment of antithymocyte globulin (ATG) in the course of Graves-Basedow steroid-resistant orbitopathy.

Setting:

Department of Ophthalmology, University Clinical Center, Medical University of Silesia, Katowice, Poland; Department of  Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland

Methods:

Bioethics committee approves the study. During ophthalmic evaluation distance and near best corrected visual acuity, intraocular pressure, exophthalomometry, kinetic and static perimetry, optical coherence tomography (OCT) of the macula and optic disc, evaluation of ganglion cells, ocular motility, visual evoked potentials and Hess screen were performed. The activity of orbitopathy was assessed using CAS scale (Clinical Activity Score), and the degree of orbitopathy was measured with NOSPECS scale. Due to the significant right eye lagophthalmos, despite local treatment (moisturizing drops, moist chamber), the presented patient developed neurotrophic ulceration in better seeing right eye.

Results:

The patient’s best corrected visual acuity improved for distance (before treatment - the right eye (RE) 1/50, after - RE 5/25f; left eye (LE) stayed unchanged) and for near (RE did not read, after RE - 1.5). Reduction in proptosis was noted (initially RE 25 mm, LE 23 mm, after the treatment RE 23 mm, LE 22 mm) which resulted in RE lagophthalmos reduction and thus contributed to the nearly complete healing of neurotrophic ulcer. Static visual field improved -reduction of relative scotomas and ganglion cell in the OCT of the macula remained stable.

Conclusions:

ATG experimental treatment improved visual acuity both to distance and near, reduction of exophthalmos. ATG treatment is effective in the active phase of thyroid orbitopathy. Due to the immunosuppressive properties of ATG,  the inclusion of the patient should be carefully assessed. The positive effects of ATG treatment have been reported in the other patients included in this study. Further observation of patients is necessary to determine the duration of the treatment effect and the frequency of ATG treatment in this group of patients.

Financial Disclosure:

None