Efficacy and systemic effects of orbital triamcinolone injection for thyroid eye disease
Author: Yuji Yamana
Base Hospital / Institution: Oculofacial Clinic Group
ePoster presentation
Abstract ID: 24-216
Purpose
Beneficial effects of orbital steroid injection for thyroid eye disease (TED) have been reported. We evaluated the efficacy and presence of ocular and systemic effects of bilateral orbital triamcinolone injections for TED.
Methods
This prospective study included patients diagnosed with TED from January 2021 to March 2023. A total of 1 mL triamcinolone acetonide (40 mg/mL) was injected inside the orbital rim, using a half-inch 27- or 30-gauge needle at four sites. We measured the CAS, MRD1 and MRD2, intraocular pressure (IOP), blood indices (thyroid panel, comprehensive metabolic panel, and serum cortisol), urinary cortisol, ocular motility (Hess area ratio [HAR%]), Hertel, MRI indices (size of extraocular muscles), and systemic adverse effects before injection and at 2 and 4 weeks after injection.
Results
We analyzed 56 eyes of 28 patients (5 men, 23 women; mean age, 38.7±11.1 years). The mean initial CAS was 4.22±1.29, which decreased to 2.20±1.10 (P<0.001) after 4 weeks. The mean MRD1 was 4.25±1.67 mm, which improved to 3.53±1.55 mm (P<0.001) after 4 weeks. The MRD2 did not improve. The mean HAR% was 94.42%±4.45%, which improved to 98.94%±6.26% (P=0.014) after 4 weeks. The IOP and Hertel remained unchanged. The coronal maximum area of the extraocular muscles decreased after 4 weeks (SR, 30.9%; IR, 36.2%; MR, 21.1%; LR, 26.9%; IO, 23.3%) (all P<0.001). The WBC and neutrophil counts increased after 2 weeks (P=0.017, P=0.021) but decreased thereafter (P=0.011, P=0.037). The levels of liver enzymes, glucose, and creatine did not worsen. Most thyroid panel indices were affected (decreases were notable in TRAb [P<0.001], TgAb [P=0.003], TPOAb [P=0.004], and free T3 [P=0.03]). The serum and urinary cortisol levels decreased after 2 weeks (P<0.001, P<0.001) but were higher after 4 weeks than at 2 weeks (P=0.027, P=0.050) (Figure 3). Adverse effects included menstrual irregularity (5/28), internal hemorrhage (5/28), acne (2/28), insomnia (2/28), and leg cramps (1/28).
Conclusion
Orbital steroid injection is effective for TED and can shrink the extraocular muscles. However, it probably has systemic effects.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Tomoyuki | Kashima | Oculofacial Clinic Group |
