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Early response to intravenous methylprednisolone therapy for restrictive myopathy in patients with thyroid eye disease

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Abstract

Purpose

To report the therapeutic efficacy of intravenous methylprednisolone (IVMP) in patients with restrictive myopathy caused by thyroid eye disease (TED).

Methods

The present prospective uncontrolled study comprised 28 patients with TED and restrictive myopathy who presented with diplopia that had developed within 6 months before their visit. All patients were treated with IVMP for 12 weeks. Deviation angle, limitation of extraocular muscle (EOM) movement, binocular single vision score, Hess score, clinical activity score (CAS), modified NOSPECS score, exophthalmometric value, and the size of EOMs on computed tomography were evaluated. The patients were divided into two groups: those whose deviation angle had decreased or remained unchanged 6 months after treatment (group 1; n = 17) and those whose deviation angle had increased in that time (group 2; n = 11).

Results

The mean CAS of the whole cohort significantly decreased from baseline to 1 month and 3 months after treatment (P = 0.03 and P = 0.02, respectively). The mean deviation angle significantly increased from baseline to 1, 3, and 6 months (P = 0.01, P < 0.01, and P < 0.01, respectively). The deviation angle decreased in 10 (36%), remained constant in seven (25%), and increased in 11 (39%) of the 28 patients. When groups 1 and 2 were compared, no single variable was identified as a cause of deviation angle deterioration (P > 0.05).

Conclusions

When treating patients with TED who have restrictive myopathy, physicians should be aware that some patients show worsening of the strabismus angle despite inflammation control with IVMP therapy. Uncontrolled fibrosis can result in motility deterioration.

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Authors and Affiliations

  1. Department of Ophthalmology, Dongguk University Gyeongju Hospital, Gyeongju, Gyeongsangbuk-Do, Republic of Korea

    Jae Ho Jang

  2. Seoul Eye Clinic, Anyang, Gyeonggi-Do, Republic of Korea

    Ji Woong Park

  3. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea

    Kyung-Ah Park & Kyung In Woo

  4. Nune Eye Hospital, Seoul, Republic of Korea

    Yoon-Duck Kim

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  1. Jae Ho Jang
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Contributions

K.I.W and J.H.J conceived and designed the study. J.H.J wrote the manuscript. J.H.J and J.W.P performed the data collection. J.H.J, K.A.P, and K.I.W analyzed the data. K.I.W and Y.D.K critically revised the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Kyung In Woo.

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The authors confirm that the study was approved by the Institutional Review Board of the Samsung Medical Center and certify that the study was performed in accordance with the ethical standards of the Declaration of Helsinki.

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Jang, J.H., Park, J.W., Park, KA. et al. Early response to intravenous methylprednisolone therapy for restrictive myopathy in patients with thyroid eye disease. Graefes Arch Clin Exp Ophthalmol 261, 2375–2382 (2023). https://doi.org/10.1007/s00417-023-06013-4

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