Copyright © Manpreet Singh Shweta Gupta, Manpreet Singh*, Manpreet Kaur, Deepti Yadav, Himanshi Singh, Zoramthara Zadeng and Pankaj Gupta Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, India *Corresponding author: Manpreet Singh, Assistant Professor, Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Submission: April 05, 2018; Published: July 24, 2018 Role of Intravenous Methylprednisolone in Moderate to Severe Thyroid Associated Orbitopathy (TAO) in Indians: A Tertiary Care Institute Study Introduction Thyroid Associated Orbitopathy (TAO) is the most common cause of bilateral and unilateral (asymmetric) proptosis in adults [1-3]. In almost 90% patients, it is associated with hyperthyroidism while euthyroid (6%), Hashimoto’s thyroiditis (3%) and primary hypothyroidism (1%) constitute the rest.[1-5]. Approximately half of Graves’ disease (ophthalmopathy, hyperthyroidism and pretib- ial myxedema) patients have ocular involvement, which is usually mild. Though, moderate to severe TAO occurs in 20-30% patients, it is the sight-threatening disease (3-5%) which require emergency intervention [2,3,5,6]. Steroids form the first-line of treatment for severe and active TAO. Many studies have documented the effec- tiveness of steroids via oral, intravenous or peribulbar route, but the optimal delivery method with minimal side effects remains in- determinate [4-10]. Although, the intravenous route is considered as more effective and better tolerated than the others, few lethal adverse events have been reported with it. [6,7,8] The aim of pres- ent study is to analyze the efficacy and safety of intravenous meth- ylprednisolone (IVMP) administered via three different protocols in the patients with sight threatening TAO. Methods We included 18 patients of previously untreated and active TAO from the oculoplastics clinic between June 2014 and April 2016. All patients met the inclusion criteria of, moderate to severe TAO (moderate/severe soft tissue involvement, eyelid retraction >2mm, exophthalmos >3mm, diplopia) and sight threatening TAO (optic neuropathy, exposure keratopathy). Thorough ophthalmological examination (including intraocular pressure and Schrimer’s test) was done at the first visit. Proptosis was measured with the Hertel’s exophthalmometer. Soft tissue involvement was documented with reference from the color atlas by EUGOGO (European group on Graves’ orbitopa- thy) [8]. the assessment of soft-tissue disease activity was carried out using the seven points of clinical activity score (CAS)- sponta- neous retrobulbar pain, pain during eye movements, conjunctival redness, chemosis, redness of eyelids, swelling of eyelids, swelling of caruncle. Each one is given 1 point and the final score was calcu- lated [9]. Eye muscle involvement was assessed using the Gorman Research Article Medical & Surgical Ophthalmology Research C CRIMSON PUBLISHERS Wings to the Research 1/5 Copyright © All rights are reserved by Manpreet Singh. Volume - 2 Issue - 3 Abstract Purpose: Aim was to report outcome in 18 patients of moderate to severe thyroid associated orbitopathy (TAO) treated with intravenous steroids (methylprednisolone). Methods: Eleven males and 7 females with mean age of 52.92 years received methylprednisolone for TAO. Examination revealed decreased vision(15), lid inflammation(15), & movement restriction(16). They were hyperthyroid(8), hypothyroid(3), euthyroid(7), & 8 had pre-existing thyroid disease. Field defects(8), apical crowding(3) and corneal involvement(4) were present. Treatment regime was, regular for 3 days(10), pulse therapy(5) & combined(3). Response to treatment was evaluated by VISA classification. Results: Improvement was seen in vision(14), inflammation(17), movement(16) and appearance(15). Determinants of poor outcome were, diabetic status, corneal involvement, raised intraocular pressure, preexisting thyroid disease and pulse therapy. Conclusion: Intravenous methylprednisolone is safe & efficacious in improving TAO in majority of acute cases along with control of co-morbid conditions. Keywords: Thyroid associated orbitopathy; Proptosis; Intravenous steroids; Methylprednisolone ISSN 2578-0360