The Clinical Research Of Comprehensive Treatments And Experimental Research Of Prostaglandin For Graves Ophthalmology

Objectives:To observe and estimate the efficiency of balanced decompression surgery plus intravenous glucocorticoids,inferomedial wall decompression surgery plus ntravenous glucocorticoids,periorbital injection,intravenous glucocorticoids and periorbital injection plus intravenous glucocorticoids for thyroid-associated opthalmopathy(TAO)patients under different self-conditions and hierarchies.To determine the levels of prostaglandins and discover the histomorphology in serum,orbital rectus,fascia,fat,lacrimal gland,periosteum and bone of TAO patients.Method:49 patients(90 eyes)were enrolled and divided into 5 groups according to the therapeutic approaches,balanced decompression surgery plus intravenous glucocorticoids(namely balanced group),inferomedial wall decompression surgery plus ntravenous glucocorticoids(namely inferomedial group),periorbital injection(namely periorbital group),intravenous glucocorticoids(namely GCs group),periorbital injection plus intravenous glucocorticoids(namely GCs+injection group).The blood and orbital tissue including orbital rectus,fascia,fat,lacrimal gland,periosteum and bone were from 41 TAO patients in order to determine the levels of prostaglandins via ELISA in blood and orbital tissue after extraction.Finally we test that in orbital tissue by immunohistochemistry staining again and observe the histomorphology of orbital tissue by H and E staining.Results:the reduction of proptosis in balanced group is better than that in inferomedial group and the response rate of both surgery groups is better than other groups who received medication,which are statistically significant.The vitual acuty is improved in all of the groups except balanced group,and the CAS has been reduced in five groups.The level of PGE2 in male is higher than control group and that of PGs reduces after GCs treatment(P<0.05).The difference of PGF2? in TAO patients and control group is not statistically significant.H and E staining depicts there are Inflammatory cell aggregation,adipose cell proliferation,hemangiectasia and proliferation of muscular mesenchyme.Conclusion:For those under sight-threatening or those who do not care of the post-operation image and wish to reduce exophthalmos dramatically,balanced decompression surgery is better.For those aiming to receive plastic surgery,inferomedial wall decompression surgery is better.For those middle to severe patients with decent physical condition,without contraindication in using glucocorticoids and sight-threatening,periorbital injection plus intravenous glucocorticoids should be used.For those with pathoglycemia or liver injury,without contraindication in using glucocorticoids,periorbital injection should be preferred.Male patients in active phase have higher level of PGE2 than control group.Glucocorticoids can actually reduce both PGE2 and PGF2?.TAO not only changed rectus and fat but periosteum and lacrimal gland.Compared with control group there are higher level of PGF2? in periosteum and fascia through immunohistochemistry staining.