Triamcinolone for the Treatment of Graves Ophthalmopathy Tested With Short Tau Inversion Recovery Magnetic Resonance

Ortiz-Basso, Tomás; Vigo, Rodolfo Luis; Sidelnik, Mariano; Vazquez-Durand, Mariana S; Shokida, Maria Felisa; Prémoli, Eduardo Jorge; García-Mónaco, Ricardo

doi:10.1097/iop.0000000000001125

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…EOMs and T2RT on MRI are one of the most objective indicators for GO severity and activity 30 . These items are widely used to evaluate the condition of GO 19,32,33 . The present study also examined EOMs and T2RT on MRI, and the results showed a notable decrease after GC treatment.…”

Section: Discussionmentioning

confidence: 71%

Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves’ ophthalmopathy

Luo

Zhang

et al. 2021

Clinical Endocrinology

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Objective Previous study suggested IgG4 levels were associated with the development of Graves’ ophthalmopathy (GO). The aims of the present study were to investigate the role of IgG4 levels in glucocorticoid (GC) treatment in GO patients. Design 69 GO patients were enrolled. Serum thyroid hormones, thyroid antibodies, IgG, IgG4, ophthalmological examinations and orbital MRI were performed. Furthermore, the clinical outcomes (a composite response endpoint including the clinical activity score (CAS), proptosis, vision, intraocular pressure, diplopia and lid width) after high‐dose intravenous GC treatment in 32 active moderate‐to‐severe GO patients were compared. Patients 69 consecutive patients with GO were asked to participate in the study. 32 of 69 GO patients were treated with high‐dose intravenous GCs. Measurements Measurement of serum IgG and IgG4, serum thyroid hormones and thyroid autoantibodies. An overall ophthalmic assessment was performed pretherapy (week 0) and post‐therapy (week 12). Results 33.3% of GO patients (23/69) had elevated IgG4 levels. IgG4 levels were positively correlated with the severity and activity of GO. After GC therapy, IgG4, IgG4/IgG, vision and CAS were significantly improved in GO patients. Patients with high IgG4 levels had a significantly reduced extraocular muscle area (EOMs) and better clinical outcomes than patients with normal IgG4 levels. Conclusions Our results suggest a possible subgroup of elevated IgG4 GO patients, with more severe ophthalmopathy and better response to GCs treatment compare with normal IgG4 GO patients.

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Section: Discussionmentioning

confidence: 71%

Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves’ ophthalmopathy

Luo

Zhang

et al. 2021

Clinical Endocrinology

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“…They concluded that PT reduces inflammation, thus improving eye movements, diplopia, and proptosis. In 2018, using nuclear magnetic resonance STIR, Ortiz-Basso et al (16) showed that the orbital anti-inflammatory benefit of PT can be observed directly in clinical improvement as well as indirectly in the reduction of orbital inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the presence of inflammation signs, we think that these patients are active. Through orbital STIR-MRI, we can detect orbital inflammation in patients with CAS <3 and administer anti-inflammatory treatments accordingly (16) . Currently, the focus of therapy in this setting is on control and the administration of eyedrops.…”

Section: Discussionmentioning

confidence: 99%

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Adverse effects associated with peribulbar injection of triamcinolone for the treatment of thyroid eye disease: a retrospective case series

Barlatay¹,

Boza²,

Basso³

et al. 2023

ABO

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Peribulbar injection of triamcinolone is an alternative treatment for thyroid eye disease; however the safety profile of this therapeutic option remains controversial. The aim of this study was to describe the occurrence of local and systemic adverse effects after peribulbar injection of triamcinolone in patients with thyroid eye disease. Methods: This was a retrospective case series. Medical records of patients with thyroid eye disease treated with peribulbar injections of triamcinolone at a single academic institution between 2007 and 2019 were analyzed. Local and systemic complications were documented. Results: A total of 123 patients were treated. Only 11 patients (8.9%) developed local complications. The most frequent complication was the presence of superficial eyelid ecchymosis (nine patients; 7.3%). Notably, systemic complications (hyperglycemic and suprarenal inhibition after stop treatment) occurred in two patients (1.6%). All complications were transient, and the patients did not have any long-term sequelae. Conclusions: Peribulbar injection of triamcinolone for the treatment of thyroid eye disease is linked to a very low rate of local or systemic complications. Prospective studies are warranted to delve into this topic.

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“…Previous studies have shown that magnetic resonance imaging (MRI) is one of the most effective examination methods for diagnosing GO and evaluating its active phase and response to treatment. [ 10 11 ] At present, there are many studies on the application of MRI in the diagnosis and treatment of GO,[ 12 13 14 15 ] but there is no study on the treatment response of GO patients whose main symptom was ULR. Therefore, this study is based on the signal characteristics of LPS muscle of GO patients with ULR in 3.0T MRI examination, to analyze the relationship between the change of LPS muscle and the effect of subconjunctival injection of triamcinolone acetonide.…”

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confidence: 99%

Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves’ ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging

Duan

Zhou

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves’ ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment. Methods: Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2-weighted, fat-suppressed fast spin echo imaging (T2WI-fs) and T1-weighted, fat-suppressed, contrast-enhanced fast spin echo imaging (T1WI-fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non-effective group. Independent t -test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t -test was used to compare SIR and T of LPS muscle before and after treatment. Then cut-off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed. Results: Sixty-two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non-effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI-fs and T1WI-fs + C decreased after treatment in the effective group ( P T2 < 0.001, P T1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non-effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non-effective treatment group on T1WI-fs + C ( P < 0.001). SIR of LPS muscle on T1WI-fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840). Conclusion: In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy.

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Triamcinolone for the Treatment of Graves Ophthalmopathy Tested With Short Tau Inversion Recovery Magnetic Resonance

Abstract: The use of parabulbar triamcinolone reduces orbital inflammation of patients with active and moderate Graves ophthalmopathy.

Cited by 6 publications

References 20 publications

Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves’ ophthalmopathy

Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves’ ophthalmopathy

Adverse effects associated with peribulbar injection of triamcinolone for the treatment of thyroid eye disease: a retrospective case series

Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves’ ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging

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