Therapy of Graves' ophthalmopathy with intravenous high-dose steroid followed by orbital irradiation.

We investigated the effects of intravenous high-dose steroid therapy followed by orbital irradiation for Graves' ophthalmopathy in eight patients. All patients presented with diplopia or fixed globes. Extraocular muscle dysfunction showed excellent improvement after the combined therapy; diplopia disappeared completely in five of them, and one patient with fixed globes showed normal eye movement. Two other patients also exhibited great improvement, although their diplopia persisted. Their ophthalmopathy index was decreased from (mean +/- SD) 4.25 +/- 0.82 to 0.75 +/- 1.48. Extraocular muscle enlargement, assessed by magnetic resonance imaging study after the radiotherapy, was also reduced after the combined therapy, although two patients did not show remarkable enlarged extraocular muscles. There was no change in extraocular muscle thickness 6-9 months after the therapy, and the ophthalmopathy index did not show change in a long follow-up (maximum 37 months after the therapy). These results suggest that high-dose methylprednisolone followed by orbital radiotherapy is a good therapeutic design for Graves' ophthalmopathy and justify a prospective randomized trial.