EFEKTIVITAS METILPREDNISOLON INTRAVENA DOSIS KUMULATIF 3 GRAM TERHADAP PARAMETER KLINIS DAN RADIOLOGIS PADA PASIEN OFTALMOPATI GRAVES FASE AKTIF SEDANG - BERAT

MUHAMAD DWI NUGROHO, Prof. Dr. dr. Agus Supartoto, Sp.M(K); Dr. dr. Retno Ekantini, M.Kes., Sp.M(K); dr. M. Robikhul Ikhsan, M.Kes., Sp.PD, KEMD, FINASIM

2022 | Tesis-Spesialis | ILMU KESEHATAN MATA

Tujuan: Menilai perubahan parameter klinis dan parameter radiologis pada pasien oftalmopati graves aktif sedang-berat setelah pemberian metilprednisolon intravena dosis kumulatif 3 gram. Metode: Penelitian ini merupakan studi eksperimental dengan desain one group pretest-posttest. Pasien oftalmopati graves aktif sedang-berat mendapat terapi metilprednisolon intravena dosis kumulatif 3 gram dengan regimen pemberian 6 minggu. Evaluasi parameter klinis dan radiologis dilakukan sebelum dan setelah pemberian terapi. Parameter klinis yang dinilai yaitu clinical activity score (CAS), fisura palpebra, proptosis dan skor diplopia. Parameter radiologis dinilai berdasarkan hasil CT scan yaitu ketebalan otot ekstraokular yang mengalami gambaran penebalan coca-cola bottle sign. Efektivitas dinilai berdasarkan kriteria responder steroid. Hasil: Terdapat perbaikan pada parameter klinis. Rata-rata CAS sebelum dan setelah terapi yaitu 3,29 +- 0,12 dan 0,95+- 0,21 (p<0,001). Rata-rata fisura palpebra sebelum dan setelah terapi yaitu 11,70+-1,94mm dan 10,70+- 1,85mm (p<0,001). Rata-rata proptosis sebelum dan setelah terapi yaitu 21,14 +- 1,94mm dan 20,00+-1,58mm (p<0,001). Skor diplopia membaik pada 3 pasien (p=0,855). Terdapat perbaikan pada parameter radiologis. Ketebalan rata-rata otot yang mengalami coca-cola sign sebelum dan sesudah terapi yaitu 4,43+-1,00mm dan 3,42+- 0,76mm (p<0,001). Efektifitis terapi berdasarkan kriteria responder steroid adalah 79%.

Objective: Assessed changes in clinical and radiological parameters in patients with moderate to severe active Graves' ophthalmopathy after administration of intravenous methylprednisolone at a dose of 3 g. Methods: This is an experimental study with one group pretest-posttest design. Patients with active moderate-to-severe Graves' ophthalmopathy were treated with intravenous methylprednisolone at a cumulative dose of 3 grams with a 6-week regimen. Evaluation of clinical and radiological parameters was evaluated before and after therapy. The clinical parameters assessed were clinical activity score (CAS), palpebral fissure, proptosis, and diplopia score. The radiological parameters that were assessed are the thickness of the extraocular muscles that had a thickened coca-cola bottle sign. Effectiveness was assessed based on the criteria for steroid responders. Results: There was an improvement in clinical parameters. The mean CAS before and after therapy were 3.29+- 0.12 and 0.95+-0.21 (p<0.001). The mean of the palpebral fissure before and after therapy was 11.70+-1.94mm and 10.70 +-1.85mm (p<0.001). The average proptosis before and after therapy was 21.14 +-1.94mm and 20.00 +- 1.58mm (p<0.001). Diplopia scores improved in 3 patients (p=0.855). There was an improvement in radiological parameters. The average thickness of muscles with the coca-cola sign before and after therapy was 4.43+-1.00mm and 3.42+- 0.76mm (p<0.001). The effectiveness of therapy based on steroid responder criteria was 79%.

Kata Kunci : oftalmopati graves, parameter klinis, parameter radiologis, metilprednisolon