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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

Threatening-to-vision GO. (a) Initial presentation of a patient with threatening-to-vision GO. LE: corneal breakdown, chemosis, conjunctival redness, eyelid swelling, swollen caruncle, retrobulbar ache at rest and with gaze, diurnal variation (inflammatory score: 9/10), proptosis > 2 mm, optic neuropathy, and extraocular muscle restriction (3/3 progression score). (b) Appearance after methylprednosolone IV treatment, amniotic membrane transplant, and lateral tarsorrhaphy in LE. (c) Appearance after bilateral orbital decompression and levator recession surgery (Dr. Barrio-Barrio and Dr. Fernandez-Hermida performed the surgical procedures).
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fig4: Threatening-to-vision GO. (a) Initial presentation of a patient with threatening-to-vision GO. LE: corneal breakdown, chemosis, conjunctival redness, eyelid swelling, swollen caruncle, retrobulbar ache at rest and with gaze, diurnal variation (inflammatory score: 9/10), proptosis > 2 mm, optic neuropathy, and extraocular muscle restriction (3/3 progression score). (b) Appearance after methylprednosolone IV treatment, amniotic membrane transplant, and lateral tarsorrhaphy in LE. (c) Appearance after bilateral orbital decompression and levator recession surgery (Dr. Barrio-Barrio and Dr. Fernandez-Hermida performed the surgical procedures).

Mentions: Depending on the severity of the exophthalmos, cases of corneal exposure keratopathy could be treated with aggressive topical lubrication, moisture chamber, botulinum toxin, levator recession surgery, tarsorrhaphy, or even orbital decompression in very severe cases of exophthalmos which impede lid closing. Intravenous methylprednisolone should be administered prior surgery if the disease is active (Figure 4).


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)

Threatening-to-vision GO. (a) Initial presentation of a patient with threatening-to-vision GO. LE: corneal breakdown, chemosis, conjunctival redness, eyelid swelling, swollen caruncle, retrobulbar ache at rest and with gaze, diurnal variation (inflammatory score: 9/10), proptosis > 2 mm, optic neuropathy, and extraocular muscle restriction (3/3 progression score). (b) Appearance after methylprednosolone IV treatment, amniotic membrane transplant, and lateral tarsorrhaphy in LE. (c) Appearance after bilateral orbital decompression and levator recession surgery (Dr. Barrio-Barrio and Dr. Fernandez-Hermida performed the surgical procedures).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: Threatening-to-vision GO. (a) Initial presentation of a patient with threatening-to-vision GO. LE: corneal breakdown, chemosis, conjunctival redness, eyelid swelling, swollen caruncle, retrobulbar ache at rest and with gaze, diurnal variation (inflammatory score: 9/10), proptosis > 2 mm, optic neuropathy, and extraocular muscle restriction (3/3 progression score). (b) Appearance after methylprednosolone IV treatment, amniotic membrane transplant, and lateral tarsorrhaphy in LE. (c) Appearance after bilateral orbital decompression and levator recession surgery (Dr. Barrio-Barrio and Dr. Fernandez-Hermida performed the surgical procedures).
Mentions: Depending on the severity of the exophthalmos, cases of corneal exposure keratopathy could be treated with aggressive topical lubrication, moisture chamber, botulinum toxin, levator recession surgery, tarsorrhaphy, or even orbital decompression in very severe cases of exophthalmos which impede lid closing. Intravenous methylprednisolone should be administered prior surgery if the disease is active (Figure 4).

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