Clinical characteristics and therapy analysis of Graves ophthalmopathy in children and adolescents

Background Juvenile Graves ophthalmopathy has a low prevalence and few relevant studies.Analyzing and reviewing the clinical features and therapeutic effectiveness of juvenile Graves ophthalmopathy is helpful to its diagnosis and management. Objective This study was to evaluate the clinical characteristics of Graves ophthalmopathy and its management in children and adolescents. Methods The clinical data of 54 eyes from 29 patients with Graves ophthalmopathy who were diagnosed in Shanghai Changzheng Hospital from January 2007 to December 2012 were retrospectively analyzed.The ocular manifestations, thyroid function, CT or MRI testing results were collected, and the activity of Graves ophthalmopathy was scored based on the criteria of CAS.Artificial tears was topically administered in 44 eyes with CAS≤2.In the eyes with CAS≥3, corticosteroids drug was systemically used in 3 patients, and orbital decompression surgery and excision of Muller muscle were performed in 3 eyes of 2 patients respectively.The follow-up was carried out for 1.5-6 years.The treatment outcomes were evaluated according to the reduction of exophthalmos and the improvement of upper eyelid retraction. Results The patients were 5-18 years old with an average age of 12.9 years old.Out of 29 Graves ophthalmopathy patients, 5 males and 24 females were included.The initial clinical manifestations were proptosis, eyelid retraction and swelling, and accompanied by conjunctival congestion and hypophasis.The best corrected visual acuity (BCVA) was ≥0.8 in all the eyes.CAS scores were 0-2 in 48 eyes of 26 patients and ≥3 (active Graves ophthalmopathy) in 6 eyes of 3 patients.The increase of orbital adipose volume was exhibited in all the eyes and the enlargement of extraocular muscle was revealed in parts of eyes by CT/MRI.Laboratory examination showed normal thyroid function in 12 patients (41.4%), hyperthyreosis in 15 patients (51.7%) and hypothyroidism in 2 patients (6.9%). The ocular symptom was improved in 20 eyes of 11 patients (37.9%), stabilized in 29 eyes of 16 patients (55.2%) and worsen in 4 eyes of 2 patients (6.9%) in following-up duration. Conclusions Graves ophthalmopathy occurs much more in female than in male.The clinical manifestations are mild, with low activity and good prognosis in children and adolescents Graves ophthalmopathy. Key words: Graves disease/complications; Graves ophthalmopathy/diagnosis; Graves ophthalmopathy/therapy; Age distribution; Children; Adolescent