The immunotherapy role in ocular hypertension management

Objective. To study the immunotherapy role in preventing edematous exophthalmos (EE). Matherials and methods. 19 patients with EE were examined: 8 people (16 eyes) with diffuse toxic goiter (DTG) on the stage of preparation for surgery or for radioactive iodine therapy, 4 people (8 eyes) with autoimmune thyroiditis (AIT), and 7 people (14 eyes) with both AIT and DTG. In all patients, a dry eye syndrome and highly active form of systemic disease were found. In the first group, to prevent edematous exophthalmos decompensation, a standard glucocorticosteroid (GC) pulse therapy during 3 days was performed; in the second group, intravenous (i/v) GC therapy during 2 days and i/v pentoxyfilline therapy; and in the third group, intravenous (i/v) GC therapy during 2 days, i/v pentoxyfilline therapy, and Restasis instillations. In all groups, a background treatment of thyroid disease was carried out. Results. Restasis therapy in edematous exophthalmos (EE) promoted not only dry eye signs leveling, but, in combination with cytokine blocker pentoxyfilline, lead to IOP and exophthalmos decrease, thus contributing to an amelioration of the optic nerve condition. Individualized approach to EE treatment consists in prevention of keratoconjunctivitis sicca and of other complications by 6 months Restasis therapy. Dry eye in endocrine ophthalmopathy (EO) will probably attract attention of endocrinologists and ophthalmologists as an early syndrome of individual predisposition to the development of complication cascade related to endocrine ophthalmopathy (EO)/ Conclusion. The proposed combined treatment appeared to be effective in influencing IOP decrease, dry eye syndrome signs and exophthalmos leveling, and acting on the optic neuropathy course.

ophthalmic hypertension, immunotherapy, edematous exophthalmos, Restasis, pentoxyfilline, glucocorticosteroids