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TOPLINE:

Percutaneous injection of triamcinolone improves margin reflex distance 1 (MRD1) and upper eyelid retraction (UER) in thyroid eye disease.

METHODOLOGY:

• In this retrospective case series, researchers included 24 patients with thyroid eye disease and UER (25 eyes; mean age, 40.8 years; 91.6% women) who received percutaneous injections of triamcinolone from three sites in Brisbane, Australia, between September 2014 and October 2022.
• The mean duration of symptoms of eye disease was 12.9 months before the first injection; patients received a mean of 2.1 injections. The mean MRD1 was 6.2 mm, and the mean UER was 3 mm before treatment.
• The primary outcome was normalization of MRD1 (< 4 mm) or improvement (at least a 0.5-mm decrease).
• Researchers also analyzed self-reported quality of life and serum levels of thyroid-stimulating hormone receptor antibodies.

TAKEAWAY:

• During a mean follow-up of 17.5 months, mean MRD1 improved by 2.2 mm and mean UER decreased by 2.42 mm (P < .001 for both).
• Quality-of-life scores improved from 4.13 to 8.02 posttreatment (P < .001), and mean serum levels of thyroid-stimulating hormone receptor antibodies decreased from 8.53 IU/L to 1.63 IU/L (P = .002).
• No patient reported clinically significant elevations in intraocular pressure.
• One patient underwent single eyelid ptosis surgery, and another had a blepharotomy due to an incomplete response after receiving a single treatment of triamcinolone.

IN PRACTICE:

"Percutaneous triamcinolone injection is an effective and safe treatment option for thyroid eye disease-related UER," which improves quality of life, the authors wrote. The treatment "can be effective in both early active disease and later presentations during the inactive phase. It may be considered a simpler and more comfortable alternative to transconjunctival injection, as it does not require upper eyelid eversion," they added.

SOURCE:

This study was led by Shaun R. Parsons, MPH, of the Division of Oculoplastic and Orbital Surgery at Royal Brisbane and Women's Hospital in Herston, Australia, and was published online on May 17 in Frontiers in Ophthalmology.

LIMITATIONS:

The study was limited by its retrospective design and lack of a placebo control group. The researchers also did not account for improvements in UER through the natural course of the disease. All pathophysiological variations of UER associated with thyroid eye disease might not benefit from this treatment.

DISCLOSURES:

No financial support was received for this study. The authors declared no conflicts of interest.