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

Yujiao Wang, Baixue Du, Mei Yang, Yanyan Zhu, Weimin He, Yujiao Wang, Baixue Du, Mei Yang, Yanyan Zhu, Weimin He

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.

Keywords: Graves' disease; dexamethasone; peribulbar injection; thyroid-associated ophthalmopathy; triamcinolone acetonide.

Copyright: © Wang et al.

Figures

Figure 1
Figure 1
Thyroid-associated ophthalmopathy signs in patients are improved after treatment. (A-D) Female patient, 23 years old; (A and B) the right eye with (A) upper eyelid retraction and (B) drooping eyelid prior to treatment. (C) No eyelid retraction and (D) no drooping after periorbital injection of triamcinolone acetonide and dexamethasone. (E-H) Female patient, 36 years old; (E) right eye with upper eyelid swelling, eyelid retraction and conjunctival edema prior to treatment; (F) drooping eyelid prior to treatment; normal eyelid when looking forward (G) and looking downward (H) after periorbital injection. (I-L) Male patient, 51 years old; (I) right eye with upper eyelid contracture, with the Hirschberg test revealing the eye position L/R=15°; (J) limited right-eye movement when looking upward; (K) normal eye position with no eyelid retraction after periorbital injection; (L) right eye movement was improved when looking upward after injection.

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