Oral abstract presentation times

Purpose

To evaluate the efficacy and safety of a triple-therapy regimen comprising intensified intravenous methylprednisolone (IVMP), early orbital radiotherapy (ORT), and adjunctive mycophenolate mofetil (MMF) in patients with dysthyroid optic neuropathy (DON).

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Methods

In this prospective cohort study, 50 consecutive ethnic Han Chinese patients (81 eyes) with DON were treated using a standardized protocol. IVMP was administered over 12 weeks (cumulative dose 8 g), with ORT (20 Gy in 10 fractions) initiated during IVMP therapy and MMF commenced concurrently. Clinical outcomes including best-corrected visual acuity (BCVA), intraocular pressure (IOP), Clinical Activity Score (CAS), exophthalmos, marginal reflex distance 1 (MRD1), and extraocular motility (EOM) were assessed at baseline and follow-up. The primary outcome was DON reversal at 24 weeks, defined as avoidance of surgical decompression.

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Results

At 24 weeks, DON reversal was achieved in 66 of 81 eyes (81%) and 37 of 50 patients (74%). Significant improvements were observed in BCVA (P=0.026), IOP (P=0.014), CAS (P=0.001), and EOM limitation (P=0.005). A shorter interval between IVMP initiation and ORT and lower baseline CAS were associated with DON reversal on univariate analysis, but no independent predictors were identified on multivariate analysis. No severe adverse events requiring treatment discontinuation occurred.

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Conclusion

Triple therapy with intensified IVMP, early ORT, and MMF is effective and well tolerated in DON, achieving high reversal rates and potentially reducing the need for surgical decompression.

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Additional Authors

First name	Last name	Base Hospital / Institution
Kelvin Kam Lung	Chong	CUHK
Fatema Mohamed Ali Abdulla	Aljufairi	CUHK
Kenneth	Wong	PWH
Clement Chee Yung	Tham	CUHK

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