球旁注射曲安奈德治疗Graves眼病的疗效观察

Effects of peri-orbital injection of triamcinolone acetomide on Graves’ ophthalmopathy

摘要:

目的:评价长效糖皮质激素治疗Graves眼病的临床效果。方法:曲安奈德40mg行患眼球旁注射,30d1次,4次为1个疗程。对治疗前和疗程结束后观察并记录眼部症状、眼征情况,并行统计学分析。结果:治疗Graves眼病30例56眼。治疗前后平均眼球突出度分别为18.2±2.2,14.6±1.8mm,相差显著(P<0.01),眼球突出回退率为84%(47/56);平均睑裂高度分别为11.6±1.7,8.4±1.1mm,相差显著(P<0.01),缩小率为80%(45/56)。B超测量眼外肌厚度情况:下、上、内、外直肌治疗前后厚度分别为6.25±1.93,4.21±1.25,6.34±1.46,4.17±1.38,5.67±1.64,3.87±1.04,4.57±1.37,3.35±0.81mm,各眼外肌厚度缩小均显著。35只视力下降眼中28眼(80%)视力改善;23例斜视和复视者,17例(74%)消失,6例(26%)得到改善,绝大部分患者畏光流泪、眼胀、眼痛等症状及结膜充血水肿、眼睑水肿等体征明显改善或消除,未见并发症。结论:球旁注射曲安奈德对Graves眼病患者的症状体征具有明显改善和消除作用,且副作用小,安全性高。

Abstract:

AIM:To evaluate the Clinical effect of triamcinolone acetomide on Graves’ ophthalmopathy.METHODS:Triamcinolone acetomide(40mg)was peri-orbitally injected in all patients.Every 30 days 1 times,4 times were a course of treatment.Visual acuity,eye symptom,exophthalmos,palpebral fissure height and eye position were measured at each visit,the thickness of extraocular muscles was measured by B-mode ultrasonography before treatment and after 6 months.RESULTS:The fifty-six eyes of 30 patients were treated.The average of exophthalmos before and after treatment were 18.2±2.2mm and 14.6±1.8mm(P<0.01),the improved rate of exophthalmia was 84%(47/56);the average height of palpebral fissure were 11.6±1.7mm,8.4±1.1mm(P<0.01),the improved rate was 80%(45/56).The thickness of extraocular muscles:inferior rectus,superior rectus,medial rectus,lateral rectus were 6.25±1.93,4.21±1.25,6.34±1.46,4.17±1.38,5.67±1.64,3.87±1.04,4.57±1.37,3.35±0.81mm respectively,the thickness of the extraocular muscles was significantly reduced.The visual acuity of 28 eyes was improved in the 35 visual acuity decreased eyes.The strabismus and diplopia of 17 patients(74%)disappeared,and 6 patients(26%)were improved in the 23 patients with strabismus and diplopia.No complication was found.CONCLUSION:Triamcinolone acetomide peri-orbital injection can improve the symptom,physical sign and the edema of the extraocular muscles,and side effects are few.