To investigate the efficacy of intravenous
methylprednisolone pulse
therapy on
Graves' ophthalmopathy (GO), fifteen patients with severe GO were treated with large dose intravenous
methylprednisolone (at a daily dosage of 1 g for 3 successive days). This treatment was repeated 3-5 times for 3-5 weeks. They were monitored before, 2 weeks after and 6 months after
therapy by ophthalmological assessment, orbital magnetic resonance imaging (MRI), and by measuring serum
antibodies to rat eye muscle (EMAB) in an
enzyme linked
immunosorbent assay and peripheral blood lymphocyte subsets by flow cytometry.
Diplopia and periorbital
edema markedly improved
after treatment in 9 patients. Mean
proptosis values and intraocular pressure measurements significantly decreased after pulse
therapy. In 12 patients enlarged eye muscles significantly reduced in size
after treatment, as determined by MRI. The overall ophthalmopathy index was improved from 4.8 +/- 2.4 to 2.5 +/- 1.6 at the end of pulse
therapy (P < 0.01) and 2.4 +/- 1.5 six months after
therapy (P < 0.01). Serum EMAB were detected in 8 out of 10 patients tested and their level significantly decreased after pulse
therapy (from 3.3 +/- 1.4 to 2.5 +/- 1.2, P < 0.01). A significant increase in peripheral blood CD4+CD45RA+ cells was observed after pulse
therapy. Increased numbers of CD11-CD8+ cells and decreased numbers of CD11+CD8++ cells were found prior to treatment and were normalized after pulse
therapy. Our study indicates that
methylprednisolone pulse
therapy can be considered as a choice for the treatment of GO. The improvement in eye muscle involvement in these patients may be due to the effects of infused
methylprednisolone on both humoral and cellular immune functions.