A型肉毒素与曲安奈德上睑结膜下注射在甲状腺相关眼病上睑退缩治疗中的对照研究

目的比较A型肉毒素与曲安奈德上睑结膜下注射治疗甲状腺相关眼病上睑退缩的疗效。方法以沈阳市第四人民医院2019年3月至2020年9月稳定期甲状腺相关眼病伴上睑退缩单眼发病病例共60例为研究对象,采用计算机随机数法进行分组:对照组30例,给予曲安奈德20 mg上睑结膜下注射1次;试验组30例,给予A型肉毒素3 U上睑结膜下注射1次。对注射后1周以及1、3、6个月各临床指标(上眼睑退缩值、上眼睑下移值、CAS评分、眼球突出度、眼压、矫正视力)变化及并发症进行比较。结果给药后1周,两组上眼睑退缩值及上眼睑下移值优于治疗后1个月时(P<0.05),试验组优于对照组;治疗后3个月时,两组比较差异无统计学意义(P>0.05);治疗后6个月两组比较差异有统计学意义(P<0.05),对照组优于试验组。对照组给药1周以及1、3、6个月后眼睑退缩值均下降,与治疗前比较差异均有统计学意义(P<0.05);试验组给药1周以及1、3个月后上眼睑退缩值均下降,与治疗前比较差异均有统计学意义(P<0.05),给药6个月后的上眼睑退缩值与治疗前比较差异无统计学意义(P>0.05);C...

A comparative study on subconjunctival injection of botulinum toxin type A and that of triamcinolone acetonide in the treatment of upper eyelid retraction in thy- roid-related ophthalmopathy

Objective To investigate the efficacy of subconjunctival injection of botulinum toxin type A into the upper lid for the treatment of thyroid-related ophthalmopathy with upper lid retraction and compare with triamcinolone acetonide.Methods A total of 60 cases of stable thyroid-related ophthalmopathy with epicanthalmia who were treated from March 2019 to September 2020 in Shenyang Fourth People′s Hospital were chosen.Computerized random number method was used to group them:30 cases in the control group were given one subconjunctival injection of triamcinolone acetonide(20 mg)and 30 cases in the experimental group were given one subconjunctival injection of botulinum toxin type A(3 U)in the upper lid.The clinical parameters(upper eyelid retraction,upper eyelid downward shift,CAS score,protrusion,intraocular pressure,corrected visual acuity)and complications were compared at 1 week,1 month,3 months and 6 months after the injection,respectively.Results The upper eyelid retraction and downward shift were better at 1 week after treatment than at 1 month in both groups,with the botulinum toxin type A group outperforming the triamcinolone acetonide group;the difference was not significant(P>0.05)at 3 months after treatment,with comparable treatment effects;the difference was significant at 6 months after treatment(P<0.05),with the triamcinolone acetonide group outperforming the botulinum toxin type A group.Within the triamcinolone acetonide group,the upper eyelid retraction values decreased at 1 week,1 month,3 months and 6 months after treatment,respectively,with significant differences compared to pre-treatment(P<0.05);within the botulinum toxin type A group,the upper eyelid retraction values decreased at 1 week,1 month and 3 months after treatment,respectively,with significant differences compared to pre-treatment(P<0.05),but there were no significant differences compared with pre-treatment at 6 months after treatment(P>0.05).There was no significant difference between the two groups in CAS score,eye prominence,IOP or corrected visual acuity or within the group before and after treatment(P>0.05).There was no significant difference in complications between the two groups(P>0.05).Conclusion The subconjunctival injection of triamcinolone acetonide and botulinum toxin type A in upper eyelid is effective and safer in the treatment of upper eyelid retraction of thyroid-related eye disease;the effect of triamcinolone acetonide is maintained longer but slower;the effect of botulinum toxin type A is faster but the duration of the drug effect is shorter,compared with triamcinolone acetonide.