Peribulbar injection of glucocorticoids for thyroid-associated ophthalmopathy and factors affecting therapeutic effectiveness: A retrospective cohort study of 386 cases

Abstract

Thyroid-associated ophthalmopathy (TAO) is common in Graves' disease. However, to date, no standard treatment has been established for TAO. The present study aimed to assess peribulbar injection of corticosteroids for TAO treatment as well as factors affecting therapeutic effectiveness. A retrospective cohort study was performed at West China Hospital, Sichuan University (Chengdu, China). Patients with TAO were administered peribulbar injection of triamcinolone acetonide and dexamethasone monthly. Ocular signs after each injection were assessed until the end of treatment. All patients were followed up for at least six months. Best corrected visual acuity, proptosis values, eye motility assessed by the Hess chart, as well as eyelid width and downward movement were determined. In addition, clinical data were retrospectively reviewed to explore factors affecting therapeutic effectiveness by logistic regression analysis. In the present study, 386 patients with TAO (515 eyes) were evaluated; 71.37% of cases of eyelid swelling were relieved and upper eyelid retraction was improved in 47.58% of affected patients. Eye movement disorders, diplopia and strabismus were all alleviated to varying degrees, with few adverse reactions. Logistic regression analysis demonstrated that therapeutic effectiveness was relatively lower in males [odds ratio (OR)=0.32, P=0.001] and patients with thyroid dysfunction (OR=0.41, P=0.002), and that non-smokers had a higher odds of substantial improvement (OR=4.62, P=0.008). The duration of TAO was not significantly associated with the clinical outcome. Patients with reduced disease severity and elevated clinical activity score exhibited higher effectiveness (all P<0.05). In conclusion, peribulbar injection of corticosteroids is effective in treating mild to moderate TAO, with the therapeutic response affected by gender, smoking and disease severity.

Clinical efficacy of dexamethasone parabulbar injection in patients with Nonarteritic anterior ischemic optic neuropathy

“…The dexamethasone was injected from the outer and outer one-third of the skin surface of the lower orbital margin. The basis for the administration plan of dexamethasone injection is that the half-life of dexamethasone is 36–54 h. After 5 weeks, optic disc edema in most patients basically subsidedA 5-mg dexamethasone parabulbar injection is a safe dose that is commonly used in clinical practice [ [16] , [17] , [18] ]. After reviewing the literature [ 6 , 7 ], the control group patients were started on 80 mg of prednisone daily (irrespective of their weight).…”

“…Parabulbar injections of steroids have a long history of use in ophthalmology for treating inflammatory conditions. This type of injection can provide long-term efficacious therapy while minimizing side effects compared with systemic glucocorticoids in uveitis, thyroid-associated ophthalmopathy, and ocular myasthenia gravis [ [16] , [17] , [18] ]. Nevertheless, few studies have reported the effectiveness and safety of parabulbar glucocorticoids in patients with NAAION.…”

Updates on the understanding and management of thyroid eye disease

“…37 In patients with either poor response to systemic steroids or with complications related to systemic steroid use, intraorbital injections of triamcinolone acetonide 20 mg and dexamethasone 4 mg have been utilized in active TED with promising results. 38,39 Bagheri and colleagues 39 showed an improvement of CAS from 5.2 to 1.6 after four monthly injections, proptosis reduction of 1.2 mm on average, and 100% and 68.2% improvement in upper and lower lid, respectively. Of the patients, 8.8% in the study developed intraocular pressure issues.…”

Revisión Bibliográfica: Glaucoma inducido por el uso de corticoides.

“…Estudio Retrospectivo de Cohorte Wang et a.l [57] 386 pacientes (515 ojos) con oftalmopatía tiroidea a quienes se les administró corticoides por inyección peribulbar.…”