球旁注射曲安奈德在甲状腺相关性眼病中的疗效观察

Therapeutic effect of periorbitally injected triam cinolone acetonide for thyroid-associated ophthalmopathy

目的:评价眶周局部注射长效激素曲安奈德(TA)对甲状腺相关性眼病(TAO)的疗效。方法:收集近2a在我院眼科门诊就诊并经相关科室确诊为甲状腺相关性眼病的患者36例60眼,男12例18眼,女24例42眼;单眼患者12例,双眼患者24例;年龄23~40(平均33±5)岁;病程2mo^4a,平均15mo;TA注射周期及疗程:3~4wk注射一次,每眼20mg/次,3~4次为一疗程。注射部位及方法:患者取仰卧位,用安尔碘消毒患眼皮肤2次。嘱患者向上方注视,由眶下缘中外1/3处紧靠眶缘进针,顺眶上壁推进直到赤道部,然后改变进针方向,稍斜向鼻下方,继续进针,深度约35mm。嘱患者上、下、左、右4个方位转动眼球,确认未刺穿眼球壁后回抽注射器,无回血时缓慢推注,将药液1m L注入球后。注射后垫以无菌纱布轻轻按压眼球5min,无出血及其它不适即可。观察研究病例眶周注射TA一个疗程后的效果,眼部症状和体征有无改善。结果:曲安奈德可明显改善患者畏光(χ2=19.326,P<0.01)、流泪(χ~2=8.500,P<0.01)、眼胀(χ~2=8.500,P<0.05)、干涩(χ~2=8.025,P<0.01)、眼睑红肿(χ~2=8.743,P<0.01)的症状,治疗后3mo突眼度(16.082±2.503mm)较治疗前(16.875±3.143mm)以及上睑后退(0.950±1.167mm)较(3.100±1.633mm)的差异有统计学意义(P<0.01),而运动受限、复视、上睑迟落无明显好转(P=0.144、0.530、0.589),本组患者治疗前后眼压组间差异无统计学意义(P=0.081)。结论:曲安奈德眶周局部注射可有效改善患者突眼度、上睑后退以及眼睛局部不适,但对于复视以及眼球运动等方面的改善不显著。

AIM：To evaluate the therapeutic effect of periorbitally injected triamcinolone acetonide（TA） for thyroidassociated ophthalmopathy.METHODS：Thirty-six patients（60 eyes） diagnosed as thyroid-associated disease by many related academics were collected in the past two years,12 male（18 eyes）and 24 female（42 eyes）,12 cases with monocular,24 with binocular,aged 23~40 years,mean 33 ±5 years.Their course of diseases were 2mo^4a,mean 15 mo.The therapy of TA：20mg for each eye once,every 3~4wk,3~4times as one course.The injection point and method：the patient took the supine position,the skin around the ocular was disinfected twice with entoiodine;the patient was asked to look upward,the needle entered at the 1/3lateral-mid point;then the needle reached the equator along the paries superior orbitae;after that,the direction of the needle changed to slightly towards inferior nasal;the depth was about 35mm;the patient was asked to move his eyeball towards different directions;1mL of the medicine was injected to the retrobulbar after making sure the eyeball was not injured and no blood in the syringe if its plunger was draw back;sterile gauze was pressed against the eyeball and make sure there was no hemorrhage or other discomforts.Observation for the therapeutic effect,including the improvement of eye symptoms and signs,after one course.RESULTS：TA had a significant efficience for relieving phengophobia（χ~2=19.326,P〈 0.01）,epiphora（χ~2=8.500,P〈 0.01）,eye-bulging（χ~2=8.500,P〈 0.05）,sensation of dryness（χ~2=8.025,P〈 0.01）,eyelid-swollening（χ~2=8.743,P〈 0.01）,but ocular movement,diplopia and Von Graefes symptom were not improved（separately P were0.144,0.530,0.589,all P〈 0.05）.Besides,protopsis（16.082±2.503mm） as compared to（16.875 ±3.143mm）and Dalrymple symptom（0.950 ±1.167mm） as compared to（3.100±1.633mm） were exactly im proved（P〈 0.01）after treatments.But intraocular pressure（IOP） of our group did not increase before and after treatments（P=0.081）.CONCLUSION：Periorbitally injected TA can improve protopsis,Dalrymple symptom and local ocular symptoms,and all patients we treated were at an normal IOP.But ocular movement,diplopia and Von Graefes symptom were not improved.