Department of Ophthalmology, Union Hospital, Tong Medical College, Huazhong University of Science and Technology, Wuhan, China.
Wuhan Sixth Hospital, Wuhan, China.
Sci Rep. 2023 Oct 7;13(1):16939. doi: 10.1038/s41598-023-43942-w.
Graves ophthalmopathy (GO) patients often undergo retrobulbar injection of glucocorticoids (GCs) as a common therapeutic approach. This study aimed to explore the impact of various patterns of extraocular muscle (EOM) enlargement on EOM changes following retrobulbar GCs injection in patients with GO. A retrospective analysis was conducted on GO patients who underwent retrobulbar GCs injections. Data pertaining to EOM diameter (EMD) and muscle diameter index (MDI) were collected from orbital computed tomography (CT) scans. The MDI change (ΔMDI) was calculated by comparing pre- and post-injection MDI values. The relationship between each pre EMD/MDI and ΔMDI was assessed using univariate and multivariate logistic regression analysis. A total of 68 patients with GO were included in this study, accounting for 118 eyes. After retrobulbar injections of GCs, 84 eyes showed a decrease in the MDI, while 34 eyes exhibited an increase in MDI. A threshold effect was observed in the relationship between medial pre EMD/MDI and ΔMDI. When the medial pre EMD/MDI was less than 0.28, a higher medial pre EMD/MDI was associated with a smaller ΔMDI (β = - 25.21, p = 0.0175). However, when the medial pre EMD/MDI was greater than 0.28, no significant association was found between pre EMD/MDI and ΔMDI. There was a negative correlation between medial + lateral pre EMD/MDI and ΔMDI (β = - 11.76, p < 0.0189). A higher medial + lateral pre EMD/MDI was associated with a greater decrease in MDI. Additionally, there was a positive correlation between superior rectus muscle-levator complex (SRLC) pre EMD/MDI and ΔMDI (β = 11.92, p = 0.040). The higher the value of SRLC pre EMD/MDI, the greater the ΔMDI. There was an association between pre EMD/MDI and changes in EOMs after retrobulbar injection of GCs in GO patients. In patients with predominantly enlarged medial rectus muscles and severe degrees of enlargement, retrobulbar injection of GCs should be assessed for its benefit; a combination of medial and lateral rectus muscle enlargement is beneficial for the shrinkage of EOMs following retrobulbar injections; the involvement of the SRLC rectus muscle may be a disadvantageous pattern of shrinkage of EOMs following retrobulbar injections.Trial registration This study is retrospectively registered. We have registered this study with the Chinese Clinical Trials Registry ( www.chictr.org.cn , registration number: ChiCTR2200063429).
格雷夫斯眼病（GO）患者常接受球后注射糖皮质激素（GCs）作为一种常见的治疗方法。本研究旨在探讨 GO 患者接受球后 GCs 注射后不同眼外肌（EOM）增大模式对 EOM 变化的影响。对接受球后 GCs 注射的 GO 患者进行回顾性分析。从眼眶计算机断层扫描（CT）中收集眼外肌直径（EMD）和肌肉直径指数（MDI）的数据。通过比较注射前后的 MDI 值计算 MDI 变化（ΔMDI）。使用单变量和多变量逻辑回归分析评估每个 EMD/MDI 与ΔMDI 的关系。共有 68 例 GO 患者纳入本研究，共 118 只眼。接受球后 GCs 注射后，84 只眼 MDI 下降，34 只眼 MDI 增加。在 EMD/MDI 与ΔMDI 的关系中观察到了阈值效应。当内侧 EMD/MDI 小于 0.28 时，较高的内侧 EMD/MDI 与较小的ΔMDI 相关（β= -25.21，p= 0.0175）。然而，当内侧 EMD/MDI 大于 0.28 时，EMD/MDI 与ΔMDI 之间没有显著关联。内侧+外侧 EMD/MDI 与ΔMDI 呈负相关（β= -11.76，p<0.0189）。较高的内侧+外侧 EMD/MDI 与 MDI 下降幅度较大相关。此外，上直肌-提肌复合体（SRLC）EMD/MDI 与ΔMDI 呈正相关（β= 11.92，p= 0.040）。SRLC 的 EMD/MDI 值越高，ΔMDI 越大。GO 患者球后注射 GCs 后，EMD/MDI 与 EOM 变化之间存在关联。在主要为内直肌增大和严重程度增大的患者中，应评估球后注射 GCs 的益处；内直肌和外直肌同时增大有利于球后注射后 EOM 的缩小；SRLC 直肌受累可能是球后注射后 EOM 缩小的不利模式。
试验注册 本研究为回顾性注册。我们已在中国临床试验注册中心（www.chictr.org.cn，注册号：ChiCTR2200063429）注册了这项研究。
