Evaluación del grosor de los músculos extraoculares y la quemosis tras tocilizumab en oftalmopatía de Graves mediante tomografía de coherencia óptica

Abstract

Purpose To assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves’ ophthalmopathy by optical coherence tomography. Methods Case series of five patients with active Graves’ ophthalmopathy (clinical activity score ≥4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o’clock (nasal and temporal). Results The study included four women and one man with a median age of 52 years (range: 38-73). Median Graves’ ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249 μm (174-366) and 337 μm (142-443), respectively. Median chemosis was 409 μm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157 μm (88-187) and 197 μm (99-290), respectively (P = .043; Wilcoxon) and chemosis to 59 μm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). Conclusions A reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves’ ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses.