Abstract ID: 26-139
Orbital Apex Triamcinolone Injection Using a Blunt Cannula for Dysthyroid Optic Neuropathy: A Report of Two Cases
Author: Yasushi Fujita Base Hospital / Institution: Oculo Facial Clinic Group
Presentation Type: ePoster Presentation
Purpose
Dysthyroid optic neuropathy (DON) is a vision-threatening complication of thyroid eye disease requiring urgent treatment. Although high-dose intravenous corticosteroids are the standard first-line therapy, their efficacy may be insufficient in some cases, and systemic adverse effects may limit their use, particularly in elderly patients. We report two cases of DON successfully treated with orbital apex injection of triamcinolone acetonide (TA) using a blunt cannula.
Methods
Two female patients (87 and 46 years) presented with DON-related visual deterioration. In Case 1, best-corrected visual acuity (BCVA) declined to 1.70 logMAR in both eyes despite two courses of intravenous methylprednisolone pulse therapy. At referral, BCVA was 1.00 logMAR (right) and 0.70 logMAR (left). In Case 2, BCVA was 0.22 logMAR (right) and 0.05 logMAR (left). Critical flicker fusion frequency (CFF) was reduced in both cases. Orbital MRI demonstrated extraocular muscle enlargement with optic nerve compression at the orbital apex and high STIR signal intensity. Under local anesthesia, a blunt 27-gauge (40-mm) cannula was advanced to the orbital apex via entry points along the superior and inferior orbital rims using a 24-gauge needle as a guide. TA (40 mg) was injected monthly for three sessions.
Results
BCVA improved to near pre-morbid levels in both cases. In Case 1, BCVA improved to 0.05 logMAR (right) and 0.15 logMAR (left). In Case 2, BCVA improved to −0.18 logMAR in both eyes. CFF improved in parallel with visual acuity. MRI showed reduction of muscle enlargement and inflammatory changes. Diplopia and upgaze limitation resolved. No complications, including orbital hemorrhage or intraocular pressure elevation, were observed.
Conclusion
Orbital apex TA injection using a blunt cannula may represent an effective and minimally invasive therapeutic option for DON. This outpatient technique may reduce reliance on repeated high-dose systemic steroid therapy. Careful technique is essential to avoid orbital complications.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Yohei | Sato | Oculo Facial Clinic Group |
| Tomoyuki | Kashima | Oculo Facial Clinic Group |