Serum samples were obtained from 65 patients with endocrine
exophthalmos class I-V. In 33/65 patients who were treated either with
prednisone or with
ciclosporin, blood was sampled before, during and after
therapy.
Antibodies against eye muscle were determined during the course of immunosuppressive therapy in order to have an objective parameter of the
therapeutic effect. To ascertain the specificity of the reaction both eye and abdominal muscles were used as
antigens in an ELISA system. Both
IgG and
IgM antibodies were detected. In 45/65 patients (71%) eye muscle
antibodies were positive before starting
therapy.
Antibodies were mostly detected in patients with active disease. Patients with
exophthalmos of recent onset always had
IgM antibodies whereas patients with chronic
exophthalmos were mostly
IgG positive. Patients with relapse showed mostly
IgG but also
IgG and
IgM positivity in 2 cases. In 58% of cases only
IgG antibodies were found whereas in 34% both
IgG and
IgM were detected and in 8% only
IgM antibodies. There was no association between
antibodies directed against eye muscle and thyroid microsomal and
thyroglobulin antibodies or with the state of thyroid function. Furthermore there was no correlation between
exophthalmos classes and eye muscle antibody binding activity. The antibody level declined during
therapy with
prednisone or with
ciclosporin but rose again 8-12 weeks after stopping the
drug in patients with progressive disease.