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Background: To describe disease parameters of patients with
Graves’ orbitopathy in a tertiary referral center in order to
plan health care resource allocations. To investigate whether
the clinical activity and/or the severity of the disease can be
used as a predictor of the duration of treatment.
Methods: Retrospective, observational, non-comparative case
series. One hundred and seventeen charts of GO-patients,
randomly chosen out of a pool of 1600, referred to the
Orbital Unit of the University Medical Centre Utrecht
between 1 January 1992 and 1 January 2002, were analysed.
Relevant parameters, such as age, gender, race, disease
duration, smoking habits, concomitant diseases, previous
treatment, symptoms and signs, number and sort of investigations,
severity and activity scores, number and sort of
treatments, treatment duration and outcome of treatment
were retrieved and analysed. Disease activity and severity at
entry were tested as possible predictors of disease duration
and extent of treatment.
Results: Clinical profile at presentation; duration of the
disease; extent of treatment; predictors of disease duration
and of number of treatment interventions were the main
outcome measures. Three percent of patients had Only Signs,
but No Symptoms (OSNS), 61% had mild, 27% had
moderately severe and 9% had severe GO. Fifteen percent
had inactive disease at presentation, 65% had borderline
activity and only 20% had active orbitopathy. Sixty percent
complained about eyelid swelling and/or proptosis. The
average period of eye treatment was 2.5 years (range: 0–
110 months), during which patients were seen at an average
of 8 times. Twenty percent needed no treatment at all. Fifteen
percent were treated with nothing but lubricants and/or
prisms. Twenty-five percent were treated with immunosuppressive
modalities. Fifty-six percent underwent one or more
surgical corrections. The Clinical Activity Score (CAS) was
found to be significantly related to the duration of the
treatment (p<0.001), to the number of visits (p<0.001), and
to the number of surgical interventions (p<0.001).
Conclusions: The majority of GO patients referred to a
tertiary referral centre has no or borderline disease activity
and ‘mild’ orbitopathy, disfiguring eyelids and proptosis
being the most frequent complaints. The disease activity as
assessed with the CAS can be used to predict the duration
and extent of the treatment
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