RESUMEN
PROPÓSITO: Evaluar el grosor de los músculos extraoculares y la quemosis tras el tratamiento con tocilizumab en pacientes con oftalmopatía de Graves activa mediante tomografía de coherencia óptica. MÉTODOS: Serie de 5 casos con oftalmopatía de Graves activa (escala de actividad clínica ≥ 4/10) tratados mediante 4 dosis de tocilizumab. Estos pacientes habían sido tratados previamente con corticoides sin mejoría. Se empleó una tomografía de coherencia óptica de dominio espectral para determinar el grosor del recto lateral y del recto medial, y la quemosis antes y después de 4 dosis de tocilizumab administradas mensualmente. Se realizó el escaneado a las 3 y 9 h (nasal y temporal). RESULTADOS: Se estudiaron 4 mujeres y un hombre con una edad mediana de 52 años (rango: 38-73). La duración mediana de la actividad fue de 17 meses (rango: 12-18). El grosor muscular mediano del recto medial y del recto lateral pretratamiento fue 249 μm (174-366) y 337 μm (142-443) respectivamente, siendo la quemosis mediana 409 μm (290-610). Tras el tratamiento con tocilizumab el grosor muscular disminuyó a 157 μm (88-187) y 197 μm (99-290) respectivamente (p = 0,043; Wilcoxon), y la quemosis a 59 μm (0-78). La escala de actividad clínica disminuyó de 5 (4-8) a 1 (0-3). CONCLUSIONES: Se observó una reducción en el grosor muscular de los rectos horizontales y en la quemosis en pacientes con oftalmopatía de Graves tras el tratamiento con tocilizumab mediante tomografía de coherencia óptica, por lo que esta técnica podría ser útil para la valoración de la respuesta al tratamiento
PURPOSE: To assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves' ophthalmopathy by optical coherence tomography. METHODS: Case series of five patients with active Graves' ophthalmopathy (clinical activity score ≥ 4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o'clock (nasal and temporal). RESULTS: The study included four women and one man with a median age of 52 years (range: 38-73). Median Graves' ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249 μm (174-366) and 337 μm (142-443), respectively. Median chemosis was 409 μm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157 μm (88-187) and 197 μm (99-290), respectively (P = .043; Wilcoxon) and chemosis to 59 μm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). CONCLUSIONS: A reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves' ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Músculos Oculomotores , Músculos Oculomotores/diagnóstico por imagen , Enfermedad de Graves/diagnóstico por imagen , Enfermedad de Graves/tratamiento farmacológico , Tomografía de Coherencia Óptica/métodos , Metilprednisolona/uso terapéutico , Enfermedades de la Conjuntiva/diagnóstico , Estudios Prospectivos , Metilprednisolona/efectos adversosRESUMEN
PURPOSE: To assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves' ophthalmopathy by optical coherence tomography. METHODS: Case series of five patients with active Graves' ophthalmopathy (clinical activity score ≥4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o'clock (nasal and temporal). RESULTS: The study included four women and one man with a median age of 52 years (range: 38-73). Median Graves' ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249µm (174-366) and 337µm (142-443), respectively. Median chemosis was 409µm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157µm (88-187) and 197µm (99-290), respectively (P=.043; Wilcoxon) and chemosis to 59µm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). CONCLUSIONS: A reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves' ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses.