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Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management.

Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC - J Ophthalmol (2015)

Bottom Line: The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making.Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided.New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Clínica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.

ABSTRACT
Graves' ophthalmopathy (GO) is an autoimmune inflammatory disorder associated with thyroid disease which affects ocular and orbital tissues. GO follows a biphasic course in which an initial active phase of progression is followed by a subsequent partial regression and a static inactive phase. Although the majority of GO patients have a mild, self-limiting, and nonprogressive ocular involvement, about 3-7% of GO patients exhibit a severe sight-threatening form of the disease due to corneal exposure or compressive optic neuropathy. An appropriate assessment of both severity and activity of the disease warrants an adequate treatment. The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making. A critical analysis of classification, assessment, and management systems is reported. A simplified "GO activity assessment checklist" for routine clinical practice is proposed. Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided. New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

No MeSH data available.


Related in: MedlinePlus

Inflammation of the plica (arrow) with diffuse conjunctival redness.
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fig3: Inflammation of the plica (arrow) with diffuse conjunctival redness.

Mentions: Soft tissue inflammatory signs and symptoms (pain, redness, and swelling) are graded with the first 8 items. Orbital pain (spontaneous or gaze evoked) should only be scored if present for more than a few seconds and more often than just occasionally. EUGOGO atlas is of great help in evaluating soft tissue inflammatory signs. Only eyelid swelling and eyelid erythema thought to be due to active GO should be scored. When swelling or erythema varies between upper and lower eyelid of an eye the more severe lid should be used to score that eye. Only “moderate” or “severe” and not “mild” eyelid swelling should be recorded as CAS positive. Some of the signs, such as redness of the conjunctiva, may be difficult to recognize because of its nonspecificity. It should be assessed without slit-lamp at 1 meter from the patient. Only redness due to active GO should be scored: diffuse redness, covering at least one quadrant. Redness of the conjunctiva as a result of corneal stippling or ulceration is not what is considered a sign of active inflammation of the orbital tissues [24]. “Equivocal” or “mild” conjunctival redness should not be given a CAS score. Chemosis is assessed with slit-lamp at 60° midway between the limbus and the lateral canthus; true chemosis (separation of conjunctiva from sclera present in >1/3 of the total height of the palpebral aperture or conjunctiva prolapsing anterior to grey line of eyelid) should be distinguished from the redundant folds of the conjunctiva (conjunctivochalasis, CAS negative). If plica is prolapsed through closed eyelids or caruncle and/or plica are inflamed (Figure 3), CAS should be recorded as positive. Increasing proptosis ≥ 2 mm in the previous 1 to 3 months is the ultimate item to evaluate swelling [27].


Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management.

Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC - J Ophthalmol (2015)

Inflammation of the plica (arrow) with diffuse conjunctival redness.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4553342&req=5

fig3: Inflammation of the plica (arrow) with diffuse conjunctival redness.
Mentions: Soft tissue inflammatory signs and symptoms (pain, redness, and swelling) are graded with the first 8 items. Orbital pain (spontaneous or gaze evoked) should only be scored if present for more than a few seconds and more often than just occasionally. EUGOGO atlas is of great help in evaluating soft tissue inflammatory signs. Only eyelid swelling and eyelid erythema thought to be due to active GO should be scored. When swelling or erythema varies between upper and lower eyelid of an eye the more severe lid should be used to score that eye. Only “moderate” or “severe” and not “mild” eyelid swelling should be recorded as CAS positive. Some of the signs, such as redness of the conjunctiva, may be difficult to recognize because of its nonspecificity. It should be assessed without slit-lamp at 1 meter from the patient. Only redness due to active GO should be scored: diffuse redness, covering at least one quadrant. Redness of the conjunctiva as a result of corneal stippling or ulceration is not what is considered a sign of active inflammation of the orbital tissues [24]. “Equivocal” or “mild” conjunctival redness should not be given a CAS score. Chemosis is assessed with slit-lamp at 60° midway between the limbus and the lateral canthus; true chemosis (separation of conjunctiva from sclera present in >1/3 of the total height of the palpebral aperture or conjunctiva prolapsing anterior to grey line of eyelid) should be distinguished from the redundant folds of the conjunctiva (conjunctivochalasis, CAS negative). If plica is prolapsed through closed eyelids or caruncle and/or plica are inflamed (Figure 3), CAS should be recorded as positive. Increasing proptosis ≥ 2 mm in the previous 1 to 3 months is the ultimate item to evaluate swelling [27].

Bottom Line: The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making.Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided.New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Clínica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.

ABSTRACT
Graves' ophthalmopathy (GO) is an autoimmune inflammatory disorder associated with thyroid disease which affects ocular and orbital tissues. GO follows a biphasic course in which an initial active phase of progression is followed by a subsequent partial regression and a static inactive phase. Although the majority of GO patients have a mild, self-limiting, and nonprogressive ocular involvement, about 3-7% of GO patients exhibit a severe sight-threatening form of the disease due to corneal exposure or compressive optic neuropathy. An appropriate assessment of both severity and activity of the disease warrants an adequate treatment. The VISA (vision, inflammation, strabismus, and appearance), and the European Group of Graves' Orbitopathy (EUGOGO) classifications are the two widely used grading systems conceived to assess the activity and severity of GO and guide the therapeutic decision making. A critical analysis of classification, assessment, and management systems is reported. A simplified "GO activity assessment checklist" for routine clinical practice is proposed. Current treatments are reviewed and management guidelines according to the severity and activity of the disease are provided. New treatment modalities such as specific monoclonal antibodies, TSH-R antagonists, and other immunomodulatory agents show a promising outcome for GO patients.

No MeSH data available.


Related in: MedlinePlus