Читать книгу Graves' Orbitopathy - Группа авторов - Страница 36

As discussed in the section “What Value Does the Mnemonic ‘NOSPECS’ Have?”, the NOSPECS classification is unsuitable for the management of GO. Instead, EUGOGO has proposed a classification of severity of relevance to patient management [67]. It is based on the impact of GO on the patient’s quality of life and the risk of visual loss. Three categories of severity are recognized: mild, moderate-to-severe, or sight-threatening as follows:

1.Mild: characteristics of GO have minimal impact on the patient’s life. They usually present one or more of the following signs:

(a)minor lid retraction (<2 mm);

(b)mild soft-tissue involvement;

(c)exophthalmos <3 mm (above the normal range for the race and gender);

(d)transient or no diplopia;

(e)corneal exposure responsive to lubricants

2.Moderate to severe: patients without sight-threatening GO whose eye disease has sufficient impact on daily life to justify the risks of immunosuppression (if active) or surgical intervention (if inactive); patients usually present one or more of the following signs:

(a)lid retraction (>2 mm);

(b)moderate or severe soft-tissue involvement;

(c)exophthalmos ≥3 mm (above the normal range for the race and gender);

(d)inconstant or constant diplopia

3.Sight-threatening GO: patients with DON or corneal breakdown due to severe exposure; other infrequent cases are ocular globe subluxation, severe forms of frozen eye, choroidal folds, and postural visual darkening; this category warrants immediate intervention

As a rule of thumb, it is considered that all patients who do not have a mild or a sight-threatening ophthalmopathy present with moderate-to-severe disease [68].