| Thyroid-associated ophthalmopathy(TAO) is one of the common orbital diseases, accounting for about 18.1%~47.1% . TAO is a kind of special orbititis, but the precise etiology and pathogenesis remains a point of debate. The predominant clinical signs of TAO include photophobia, weeping, loss of visual acuity, proptosis, soft tissue swelling, chemosis, abnormal lid position, diplopia, and motility disturbances. It is easy to be diagnosed but difficult to be treated for TAO. The effective treatment of TAO includes medicine, ocular radiation and surgery. Corticosteroids can inhibit immune reaction and inflammatory reaction, reducing the proliferation of retrobulbar fibroblasts and the release of glycosaminoglycan, and is suitable for the treatment of active TAO. Since the side-effect incidence of corticosteroids used systemically is up to 90%, it was suggested to use corticosteroids topically. Triamcinolone acetonide, a kind of derivative of triamcinolone, has better efficacy that can last for 2-3 weeks when used topically. In this investigation we used triamcinolone acetonide to treat activate TAO by the way of intraorbital injection to search a safe andeffective method for mild active TAO. Materials and Methods1. Case choices: 32 cases (46eyes) of active TAO were brought into the investigation. 16 of 32 patients suffered with diplopia. All the eyes presented with eye-lid signs and inflammatory findings, and 17 eyes with the decrease of visual acuity, 21 eyes with proptosis, 30 eyes with motility disturbances, 8 eyes with corneal involvement. The mean clinical activity score and eye-disease index of 46 eyes were 7.67+1.49 and 4.28 + 0.28 respectively.2. Drugs and injection methods: According to the clinic signs and coronary orbit CT scans, we injected drugs including 40mg triamcinolone acetonide, 5mg dexamethasone, 20000u gentamicin, 0.5ml lidocaine into involved tissue. Commonly the next injection was done after 2-3 weeks and 3 times made one period till stabilization.3. Parameters observed: Naked and corrected vision was tested by standarded logarithm vision chart, degree of proptosis was tested by Hertel exophthalmometer, signs of ocular inflammatory were noted, corneal was examined by slit-lamp microscope, oculomotor and diplopia was checked by Hess screen every time when patients on outpatient. All the side-effects of corticosteroids and complications of intraorbital injection were also enregistered. Results1. Times of injection: The mean times of injection on one eye was 3.1 and on one patient was 4.6.2. Effect: (1) Visual acuity: Visual acuity increased up to 1.0 or over it in 6 eyes, increased more than 2 lines in 6 eyes, and the effective rate was 70.6%. (2)Proptosis: Proptosis reduced to 17mm or below in 10 eyes, reduced more than 2mm in 2 eyes, and the effective rate was 57.1%. But there was no distinct improvement in 5eyes with severe proptosis. (3)Signs of inflammatory in soft tissue: Activate signs disappeared or distinctly alleviated in 37eyes and the effective rate was 80.4%. Lid swelling disappeared in 20 eyes, alleviated from moderate to mild in 23 eyes and the effective rate was 97.7%. Swelling in lacrimal district disappeared in 18 eyes, alleviated from moderate to mild in 22 eyes and the effective rate was 95.2%. Conjunctival congestion disappeared in 40 eyes and the effective rate was 93.0%. Chemosis disappeared in 21 eyes and the effective rate was 95.5%. Swelling in lacrimal caruncle disappeared in 37 eyes and the effective rate was 94.9%. (4) Eyelid signs: Palpebral fissure reduced to 9mm or below in 20 eyes, reduced more than 2mm in 14 eyes and the effective rate was 90.0%. Upper eyelid retraction disappeared in 22 eyes, reduced more than 2mm in 15 eyes and the effective rate was 92.5%. All the upper eyelid lag in 29 eyes disappeared. Lower eyelid retraction disappeared in 2 eyes, alleviated more than 2mm in 2 eyes and the effective rate was 50%. (5) Motility disturbances and di... |
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