甲状腺相关性眼病处理的新视角:局部注射疗法

Therapy insight: local injections for the treatment of thyroid associated ophthalmopathy

甲状腺相关性眼病(TAO)是自身免疫性甲状腺疾病的主要外在表现,也是临床治疗的难点。中、重度和活动性TAO的一线方案即大剂量糖皮质激素脉冲治疗的疗效有限且不良反应令人担忧。而眼眶局部注射治疗不仅能够有效改善患者的临床症状,降低TAO的活动性和严重度,且相较于全身用药而言,不良反应更少,可以成为新的治疗选择。A型肉毒毒素、透明质酸、糖皮质激素、生长抑素类似物和新型生物制剂等多种药物已被尝试用于眼眶局部注射。

Thyroid associated ophthalmopathy (TAO) is the main extrathyroidal manifestation of autoimmune thyroid diseases.It is also very difficult to manage the patients with severe orbital involvement.The high-dose glucocorticoid via the intravenous route is the first-line therapy for moderate-to-severe and active TAO,which is unsatisfied with the limited efficacy and adverse events.Orbital topical injection therapy can not only effectively improve the clinical symptoms and reduce the activity and severity,but also lower the incidence of adverse events compared with systemic administration.Therefore,it can be used as an adjuvant method in the treatment of TAO.Several drugs,including botulinum toxin type A,hyaluronic acid,somatostatin analogs,glucocorticoids,and new immunomodulatory agents,have been tried in orbital topical injection.