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N. Komoto, A. Kozaki, R. Inoue, T. Inoue, T. Maeda, T. Inoue, Y. Inoue; Treatment of Dysthyroid Ophthalmopathy With Superior Eye Lid Injection of Triamcinolone. Invest. Ophthalmol. Vis. Sci. 2009;50(13):650.
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This study was conducted to assess the therapeutic efficacy of triamcinoline injection therapy on lid retraction and swelling associated with dysthyroid ophthalmopathy.
The subjects of this study consisted of 29 eyes of 21 cases of dysthyroid ophthalmopathy that were injected with triamcinoline (40mg) via the conjunctiva of the upper eyelid for treatment of lid retraction and swelling and then monitored for three months or more. The subjects consisted of 5 eyes of 3 men and 24 eyes of 18 women. The average age was 43 years. The proptosis as measured by MRI had an average value of 18.9 mm. To determine side effects of the treatments, palpebral fissure height, degree of swelling, sizes of the superior rectus muscle (SR) and levator palpebrae superioris muscle (levator) as determined by MRI were evaluated after treatment and compared to the respective value before treatment.Efficacy was evaluated by defining improvement of palpebral fissure height of 1 mm or more as indicating efficacy against lid retraction and evaluating swelling on the basis of photographs of the external eye at three months after treatment.
Treatment for lid retraction was performed on 20 eyes while treatment for swelling was performed on 22 eyes (some eyes underwent treatment for both). The average palpebral fissure height was 9.6 mm before treatment and 8.7 mm after treatment, demonstrating a significant decrease (P<0.05). There were 11 eyes (55%) in which treatment was effective for lid retraction and 19 eyes (86%) in which treatment was effective for swelling. Although there were no changes observed in surface area of the SR before and after treatment, that of the levator decreased significantly (P<0.05). T2-SIR, which is an indicator of inflammatory activity of the extraocular muscle, was significantly decreased after treatment in both cases (P<0.05). Side effects consisted of 1 eye exhibiting ocular hypertension (Max.27mmHg) that occurred 3.5 months after the injection.
Although triamcinoline injection therapy demonstrated somewhat low efficacy against lid retraction, it was thought to be extremely effective against eyelid swelling.
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