Abstract
Purpose :
The efficiency of the parabulbar triamcinolone for treating the Thyroid – Associated Ophthalmopathy (TAO) is a controversial issue. We performed a quasi – experimental prospective study to assess if the parabulbar triamcinolone is effective and safe so as to decrease the orbital inflammation in patients presenting moderate to severe TAO.
Methods :
It was carried out on patients who suffered from a moderate to severe active Thyroid – Associated Ophthalmopathy.
Through orbital STIR magnetic resonance imaging it was assessed whether the Signal Intensity Ratio (SIR) of the extraocular muscles decreased after a treatment with parabulbar acetonide triamcinolone. Furthermore, the Clinical Activity Score (CAS) was analyzed together with the exophthalmometry, before and after the treatment.
Criteria to exclude patients from the treatment were applied to those suffering from orbitopathy of other ethiology, who had undergone surgery during the 6 previous months, those treated with local or systemic corticosteroids during the 6 previous months. A T – test for paired data was used for statistical analysis.
Results :
There were included 15 patients and 28 orbits for the analysis. The average age was 42 years (SD 15,47) and 66% (n10) were women.
The average SIR for the inferior rectus was 4.07 (SD 1.4) before the treatment and 2.67 (SD 0.93) (p 0.0003) after it; in the case of the superior rectus the average SIR was 3.57 (SD 0.86) and 2.8 (SD 0.44) (p 0.0002) after the treatment; in the case of the external rectus that value was 3.65 (SD 0.76) before the treatment and 2.8 (SD 0.4) (p 0,0002) after the treatment; and finally, for the internal rectus the average SIR was 3.93 (SD 1.1) before the treatment and 3.1 (SD 0.58) (p 0.0026) after the treatment.
No patient presented local or systemic complications after the treatment.
Conclusions :
The treatment with parabulbar triamcinolone is effective and safe do decrease SIR in patients presenting moderate to severe thyroid-associated ophthalmopathy.
Although further studies are necessary to compare the efficiency and safety of local and systemic corticosteroids applying this technique, they can be effectively replaced when the risk of systemic corticosteroids are greater than the benefits.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.