Purpose We evaluated the frequency o f long-term compli-cations of orbital irradiation(radiation-induced tumors,cataract,and retinopathy)in comparison with glucocorti-coids.Design We conducted a follow-up study in a c...Purpose We evaluated the frequency o f long-term compli-cations of orbital irradiation(radiation-induced tumors,cataract,and retinopathy)in comparison with glucocorti-coids.Design We conducted a follow-up study in a cohort of 245Gravesophthalmopathy patie nts who had been treated with retrobulbar irradiation(20Gy in 2weeks)and /or oral glucocorticoids between 1982and 1993in our institution.Irradiated patients were compared with nonir-radiated patients.Methods Data on mortality and cause of death were obtained.Living patient s were invited to par-ticipate in a follow-up study.Possible retinopathy was as-sessed in a masked fashion and defined as the presence of≥1hemorrhages and /or microaneurysm son red-free retina photographs.If>5lesions were present,patients were categorized as suffering from defin ite retinopathy.Cataract was assessed using the Lens Opacity C lassification System II score.Main outcome measures Mortality,prevalence of retinopathy,prevalence of catarac t,and type of cataract.Results Thirty-seven of the 245pati ents had died,none of them from an intracranial tumor.Mortality was similar in the irradiated(27/15917%-)and nonirradiated pa-tients(10/8612%;P=0.264).One hundred fifty-seven of the 208living patien ts(75%)consented to participate in a follow-up ophthalm ologic investigation;the mean follow-up time (±standard deviation)was 11±3years.Possible retinopathy was pre sent in 15%of pa-tients,22of the irradiated and 1of t he nonirradiated pa-tients(P=0.002).In 5patients(all had been irradiat-ed),definite retinopathy(i.e.,>5retinal lesions)was present.Of these,3had diabetes mellitus,and 1had hypertension.Diabetes was associa ted with both possible(P=0.029)and definite(P=0.005)retinopathy,with a relative risk of 21(95%confidence interval,3-179).The prevalence and severity of cataract were similar in the radiotherapy group(29%)and the glucocorticoid group(34%);it should be noted that 88of 104of th e irradiated patients were also treated with oral glucocorticoids.Con-clusion The data suggest that orbita l irradiation for Graves’ophthalmopathy is a safe treatment m odality,except possibly for diabetic patients.展开更多
文摘Purpose We evaluated the frequency o f long-term compli-cations of orbital irradiation(radiation-induced tumors,cataract,and retinopathy)in comparison with glucocorti-coids.Design We conducted a follow-up study in a cohort of 245Gravesophthalmopathy patie nts who had been treated with retrobulbar irradiation(20Gy in 2weeks)and /or oral glucocorticoids between 1982and 1993in our institution.Irradiated patients were compared with nonir-radiated patients.Methods Data on mortality and cause of death were obtained.Living patient s were invited to par-ticipate in a follow-up study.Possible retinopathy was as-sessed in a masked fashion and defined as the presence of≥1hemorrhages and /or microaneurysm son red-free retina photographs.If>5lesions were present,patients were categorized as suffering from defin ite retinopathy.Cataract was assessed using the Lens Opacity C lassification System II score.Main outcome measures Mortality,prevalence of retinopathy,prevalence of catarac t,and type of cataract.Results Thirty-seven of the 245pati ents had died,none of them from an intracranial tumor.Mortality was similar in the irradiated(27/15917%-)and nonirradiated pa-tients(10/8612%;P=0.264).One hundred fifty-seven of the 208living patien ts(75%)consented to participate in a follow-up ophthalm ologic investigation;the mean follow-up time (±standard deviation)was 11±3years.Possible retinopathy was pre sent in 15%of pa-tients,22of the irradiated and 1of t he nonirradiated pa-tients(P=0.002).In 5patients(all had been irradiat-ed),definite retinopathy(i.e.,>5retinal lesions)was present.Of these,3had diabetes mellitus,and 1had hypertension.Diabetes was associa ted with both possible(P=0.029)and definite(P=0.005)retinopathy,with a relative risk of 21(95%confidence interval,3-179).The prevalence and severity of cataract were similar in the radiotherapy group(29%)and the glucocorticoid group(34%);it should be noted that 88of 104of th e irradiated patients were also treated with oral glucocorticoids.Con-clusion The data suggest that orbita l irradiation for Graves’ophthalmopathy is a safe treatment m odality,except possibly for diabetic patients.
