Clinical Ophthalmology (Sep 2024)
Efficacy and Systemic Effects of a Single Deep Orbital Triamcinolone Injection for Thyroid Eye Disease
Abstract
Yuji Yamana,1 Tomoyuki Kashima,1 Masashi Mimura1– 3 1Department of Ophthalmology, Oculofacial Clinic Group, Tokyo, Japan; 2Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan; 3Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, JapanCorrespondence: Yuji Yamana, Oculofacial Clinic, Tokyo, Japan, Email [email protected]: Orbital steroid injections offer a potential therapeutic avenue for managing Thyroid Eye Disease (TED). This study aimed to assess the effectiveness and potential systemic impacts of a single deep orbital triamcinolone injection in TED patients.Methods: In a prospective investigation conducted from January 2021 to March 2023, patients diagnosed with TED were enrolled. Inclusion criteria encompassed a Clinical Activity Score (CAS) of ≥ 3, extraocular muscle inflammation, and upper eyelid retraction. A total of 1 mL of triamcinolone acetonide (40 mg/mL) was administered posterior to the orbital septum at both the medial and lateral aspects of both the upper and lower eyelids. Parameters, including CAS, margin-reflex distances (MRD1 and MRD2), intraocular pressure (IOP), ocular motility (Hess area ratio [HAR%]), exophthalmometry, extraocular muscle size, and blood and urinary indices, were evaluated before and at 2 and 4 weeks after a single injection.Results: Analysis included 28 patients (23 women, 5 men; mean age (SD): 38.7 (11.1) years), representing 56 eyes. Following the injection at 4 weeks, the mean CAS and MRD1 significantly decreased by 2 points and 0.8 mm, respectively. There was a 4.5% increase in HAR%, and extraocular muscle size decreased by 4 to 15.3 mm². Neutrophil count, C-reactive protein, and thyroid antibodies significantly decreased. No severe adverse ophthalmic or systemic effects, including IOP increases or liver damage, were observed.Conclusion: Bilateral single orbital triamcinolone injections provided relief from TED symptoms through both direct effects on orbital soft tissue and systemic effects by decreasing antibody reactions.Keywords: thyroid eye disease, orbital steroid injections, triamcinolone, extraocular muscles
