Plasma exchange therapy for severe Graves' ophthalmopathy

In the present studies, the authors report on the treatment of nine Graves' disease patients with severe ophthalmopathy by use of intensive plasma exchange followed by immunosuppression (during three to six months). Results of treatment were evaluated by comparing the ophthalmopathy index and the orbital CT scan performed before and after plasmapheresis. Favorable results were obtained in eight out of nine patients, i.e., in all patients who exhibited evolutivity of their ocular signs and symptoms. The best positive effects of plasmapheresis were observed for soft tissue involvement, proptosis, tonometry, and visual acuity. Furthermore, a significant reduction in the size and density of enlarged extraocular muscles was also found. Six months after withdrawal of immunosuppression, three patients presented a moderate recurrence of ophthalmopathy and were treated successfully by a second course of plasmapheresis, followed by a short immunosuppression.In conclusion, the use of intensive plasma exchange associated with immunosuppression is an effective approach to the treatment of severe Graves' ophthalmopathy. It yields rapid and dramatic improvements that are maintained in most patients after withdrawal of immunosuppression. Recurrences are still responsive to the beneficial effects of this combined treatment.