Medium-dose intravenous methylprednisolone pulse therapy for thyroid-associated orbitopathyOA

●AIM:To evaluate the efficacy and safety of a mediumdose intravenous methylprednisolone(IVMP)pulse regimen for moderate-to-severe active thyroid-associated orbitopathy(TAO),with change in clinical activity score(CAS)as the primary outcome.●METHODS:This prospective interventional study was conducted at a tertiary eye care center in Bangladesh between February and November 2022.Patients with active moderate-to-severe TAO(CAS≥3)received IVMP totaling 4.0 g(500 mg daily for 3 consecutive days,followed by 500 mg every 3wk for 5 cycles).Clinical outcomes,including CAS,proptosis measured by Hertel exophthalmometry,bestcorrected visual acuity(BCVA;logMAR),and intraocular pressure(IOP),were assessed at baseline and at 6mo.●RESULTS:A total of 30 patients with active TAO were enrolled and completed the 6-month follow-up.The mean age of the participants was 38.63±12.11y,and 19(63.3%)were male.The mean CAS decreased significantly from 3.66±1.03 to 0.87±0.63(mean change−2.79±0.95;P<0.0001).The mean degree of proptosis decreased from 22.47±1.59 to 20.13±1.97 mm(−2.34±1.25 mm;P<0.0001).BCVA improved from 0.46±0.31 to 0.15±0.18 logMAR(−0.31±0.28;P=0.02).The mean IOP decreased from 16.80±3.56 to 14.93±1.73 mm Hg(−1.87±2.45 mm Hg;P<0.001).Eyelid swelling,conjunctival redness,chemosis,and retro-orbital pain resolved in more than 90%of patients.Adverse events,including transient increased IOP(26.66%),hyperglycemia(20.00%),and elevated SGPT(6.67%),were mild and reversible;no severe hepatic,cardiovascular,or psychiatric complications occurred.●CONCLUSION:Medium-dose IVMP(4.0 g)significantly improve disease activity,proptosis,visual acuity,and IOP,with an acceptable safety profile.This regimen represents an effective and safer alternative to high-dose IVMP for active moderate-to-severe TAO,particularly in resourcelimited settings.Larger,multicenter trials with longer followup periods are needed to confirm these findings.