Luo L H, Gao L X, Wang W, Miao H, Ma X M, Li D M
Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2020 Jul 11;56(7):524-529. doi: 10.3760/cma.j.cn112142-20191009-00504.
To evaluate the efficacy of triamcinolone acetonide deep fornix injection for the treatment of upper eyelid retraction caused by thyroid-associated ophthalmopathy (TAO). Case-control study. A retrospective analysis was conducted on 64 eyes in 53 patients with upper eyelid retraction caused by TAO from October 2015 to December 2018. Thirty-nine eyes in 33 patients diagnosed with TAO with upper eyelid retraction were treated with triamcinolone acetonide deep fornix injection (20 mg), once per month until the therapeutic effect was stable, as the treatment group. Twenty-five eyes in 20 patients were not treated (the observation group). The ocular examination indexes of the two groups were compared. Paired -test and independent sample -test were used for statistical analysis. There were 6 males and 27 females in the treatment group, aged (43±12) years, and 5 males and 15 females in the observation group, aged (40±13) years. There was no significant difference in gender, age, history and baseline ocular examination indexes between the two groups (all 0.05). In the treatment group, the number of injections was (2.18±0.94) times (range, 1 to 5 times). After (6.74±3.89) months of follow-up, the marginal reflex distance (MRD1) was reduced from (6.85±0.88) mm to (4.38±1.04) mm, the score of quality of life in thyroid eye disease (TED-QOL) was reduced from 22.03±4.33 to 7.91±3.25, and the clinical activity score (CAS) was reduced from 2.82±0.39 to 0.97±0.39 (14.68, 21.36, 20.92; all 0.01). There was no statistically significant difference in the degree of exophthalmos, intraocular pressure, the diameter of the rectus muscle measured by B-ultrasound before and after treatment (all 0.05). After (8.65±5.15) months of follow-up, the eyelid retraction also improved in the observation group, but the improvement was more obvious in the treatment group. The differences of MRD, TED-QOL and CAS before and after treatment in the treatment group were (2.46±1.05) mm, 14.06±3.80 and 1.85±0.51 respectively, which were significantly higher than those before and after the follow-up in the observation group [(0.32±0.75) mm, 3.24±2.86 and 0.56±0.58, respectively; 8.86, 11.90, 8.98; all 0.01]. There was no recurrence in the two groups. In the treatment group, 5 patients (6 eyes) showed a transient intraocular pressure rise, which was controlled after medication; 3 women had menstrual changes. Deep fornix injection of triamcinolone acetonide for treating upper eyelid retraction is convenient and effective. It can significantly reduce symptoms and improve patients' quality of life. .
评估曲安奈德深穹窿注射治疗甲状腺相关性眼病（TAO）所致上睑退缩的疗效。病例对照研究。对2015年10月至2018年12月期间53例TAO所致上睑退缩患者的64只眼进行回顾性分析。将33例诊断为TAO伴上睑退缩的患者的39只眼用曲安奈德（20mg）进行深穹窿注射治疗，每月1次，直至治疗效果稳定，作为治疗组。20例患者的25只眼未接受治疗（观察组）。比较两组的眼部检查指标。采用配对t检验和独立样本t检验进行统计学分析。治疗组男6例，女27例，年龄（43±12）岁；观察组男5例，女15例，年龄（40±13）岁。两组在性别、年龄、病史及基线眼部检查指标方面差异均无统计学意义（均P>0.05）。治疗组注射次数为（2.18±0.94）次（范围1至5次）。随访（6.74±3.89）个月后，边缘反射距离（MRD1）从（6.85±0.88）mm降至（4.38±1.04）mm，甲状腺眼病生活质量评分（TED-QOL）从22.03±4.33降至7.91±3.25，临床活动评分（CAS）从2.82±0.39降至0.97±0.39（P<0.01）。治疗前后眼球突出度、眼压、B超测量的直肌直径差异均无统计学意义（均P>0.05）。随访（8.65±5.15）个月后，观察组上睑退缩也有改善，但治疗组改善更明显。治疗组治疗前后MRD、TED-QOL及CAS的差值分别为（2.46±1.05）mm、14.06±3.80及1.85±0.51，均显著高于观察组随访前后的差值[分别为（0.32±0.75）mm、3.24±2.86及0.56±0.58；P<0.01]。两组均无复发。治疗组5例（6只眼）出现一过性眼压升高，药物治疗后得到控制；3例女性出现月经改变。曲安奈德深穹窿注射治疗上睑退缩方便有效，可显著减轻症状，提高患者生活质量。
