Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.
Department of Ophthalmology, Istanbul University, Istanbul, Turkey.
Orbit. 2021 Oct;40(5):381-388. doi: 10.1080/01676830.2020.1814351. Epub 2020 Sep 4.
To evaluate the efficacy and complications of transconjunctival Botulinum toxin A injections performed according to an algorithm, for the management of upper eyelid retraction associated with thyroid eye disease.
Seventy one eyes of 60 patients at the inactive stage, who had undergone Botulinum toxin A injection were reviewed retrospectively. Botulinum toxin A was injected transconjunctivally, just above the superior tarsal border of the upper eyelid in doses between 2-15 units according to an algorithm, depending on the amount of retraction. Margin-reflex distances were measured according to the photographs taken under standard conditions before and after the injections at the tenth day, then the second month and the fourth month. Additional Botulinum toxin A injections were performed in patients who had an undercorrection on the tenth day. Complications such as diplopia and ptosis were recorded.
The study included 38 females, 22 males with a mean age of 43.3 ± 13.1. Normal margin-reflex distances (3-4 mm) were reached in the 58 of 71 eyes (81.7%). Additional injections were needed in eight eyes (11.2%) for residual retraction on the tenth day. Ptosis was the major complication in four eyes for 1-3 weeks after injection. Upper eyelid retraction recurred after 5.1 ± 0.9 months in all patients.
In the treatment of upper eyelid retraction due to thyroid eye disease, transconjunctival injection of Botulinum toxin A is an effective, safe, transient, and repeatable method with few complications in patients. The algorithm used in this study resulted in high success rate in long-term follow-up.
评估根据算法进行的经结膜肉毒杆菌毒素 A 注射治疗甲状腺眼病相关上睑退缩的疗效和并发症。
回顾性分析 60 例静止期患者的 71 只眼，这些患者均接受过肉毒杆菌毒素 A 注射。根据算法，在距上睑缘上方结膜约 2-15 个单位的位置进行经结膜注射，具体剂量取决于上睑退缩的程度。在注射前、注射后第 10 天、第 2 个月和第 4 个月，在标准条件下拍摄照片，根据照片测量边缘反射距离。如果第 10 天出现矫正不足，需要对患者进行额外的肉毒杆菌毒素 A 注射。记录复视和上睑下垂等并发症。
研究纳入 38 名女性和 22 名男性，平均年龄为 43.3±13.1 岁。71 只眼中有 58 只（81.7%）达到正常的边缘反射距离（3-4mm）。第 10 天仍有上睑退缩的 8 只眼（11.2%）需要额外注射。注射后 1-3 周有 4 只眼出现上睑下垂，持续 1-3 周。所有患者的上睑退缩在 5.1±0.9 个月后均复发。
在甲状腺眼病引起的上睑退缩的治疗中，经结膜注射肉毒杆菌毒素 A 是一种有效、安全、短暂且可重复的方法，并发症少。本研究中使用的算法在长期随访中取得了较高的成功率。
