Efficacy and Safety of Biweekly Sheath-Guided Orbital Triamcinolone Injection: Report of Three Cases
Author: Yuji Yamana
Base Hospital / Institution: Oculofacial Clinic Group
ePoster presentation
Abstract ID: 25-190
Purpose
We developed a biweekly sheath-guided orbital triamcinolone injection (SG-OTI) for severe thyroid eye disease (TED) and report the outcome in three patients.
Methods
SG-OTI was performed by puncturing the orbital septum with a 24G needle and guiding a 27G dull needle to four different muscle sites to deliver a 1 mL injection of triamcinolone (40 mg/mL).
Results
Case 1: A 66-year-old woman with dysthyroid optic neuropathy (DON) underwent six biweekly SG-OTIs. Visual improvement was achieved after five sessions. Best-corrected visual acuity improved from 20/32 to 20/16 in the right eye and from 20/500 to 20/20 in the left eye. Critical flicker fusion frequency improved from 20.3/9.3 Hz to 35.0/31.0 Hz, clinical activity score (CAS) from 7 to 1, and exophthalmos from 21/21 mm to 21/18 mm. The average coronal cross-sectional area of the extraocular muscles (EOMs) on magnetic resonance imaging (MRI) was reduced by 56.7%. Subcutaneous hemorrhage without intraocular pressure (IOP) elevation occurred as a complication.
Case 2: A 67-year-old woman with DON received seven biweekly SG-OTIs. Visual improvement occurred after four sessions. Best-corrected visual acuity improved from 20/25 to 20/16 in the right eye and from 20/100 to 20/16 in the left eye. CAS improved from 7 to 3, and exophthalmos from 19/20 mm to 17/17 mm. The average cross-sectional area of the EOMs on MRI was reduced by 61.2%. No complications occurred.
Case 3: A 56-year-old woman with severe TED received six biweekly SG-OTIs. The CAS improved from 7 to 3, and exophthalmos from 25/25 mm to 21/22 mm. The average cross-sectional area of the EOMs on MRI was reduced by 49.3%. No complications occurred.
Conclusion
Biweekly SG-OTIs appear to be safe and effective for treating the most severe cases of TED, including DON.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Tomoyuki | Kashima | Oculofacial Clinic Group |
