激素冲击联合眶周注射治疗甲状腺相关性眼病

目的:评价甲基强的松龙冲击联合曲安奈德和地塞米松眶周注射治疗甲状腺相关眼病的临床效果。方法:对36例53眼甲状腺相关眼病患者以甲基强的松龙500mg静滴,连用3d;后改用曲安奈德40mg+地塞米松2.5mg行患眼眶周注射,1次/mo,连续注射3次,疗程结束后1,3mo随访观察记录自觉症状、眼部体征。结果:治疗后患眼平均眼球突出度下降(3.4±1.2)mm,肌肉厚度减幅(1.1±0.3)mm,治疗前后差异均有统计学意义;自觉症状及其他眼部体征也均有改善。结论:甲基强的松龙冲击联合曲安奈德和地塞米松眶周注射治疗甲状腺相关眼病效果明显,不良反应小,安全可靠。     

半球后注射曲安奈德治疗甲状腺相关眼病

目的:评价半球后注射曲安奈德(triamcinolone acetonide,TA)治疗甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)的临床效果。方法:对46例84眼甲状腺相关眼病患者以TA40mg加20g/L利多卡因0.5mL行眼部半球后注射,每3wk1次,连续4次为1疗程,1,3,6mo随访观察,记录眼部症状、体征情况。结果:患者43例自觉症状明显改善,眼球回退率83.6%,眼裂宽度缩小率85.2%,双眼视力改善率80.9%,眼球运动障碍、复视、斜视改善率80.5%。结论:半球后注射TA治疗甲状腺相关眼病效果明显,不良反应小,安全可靠。     

糖皮质激素和环磷酰胺及奥曲肽治疗Graves眼病的临床疗效

目的:探究糖皮质激素、环磷酰胺、奥曲肽三种药物治疗Graves眼病(GO)的临床疗效。方法:回顾性研究。选取2018-06/2019-10我院收治的GO患者102例152眼,按治疗方式分为糖皮质激素组(33例51眼)、环磷酰胺组(38例59眼)与奥曲肽组(31例42眼),总疗程12wk。比较三组患者治疗效果,治疗前后眼球突出度、复视、眼内压、视力变化情况,并进行甲状腺相关眼部活动度评分(CAS);经眼部超声检查眼轴、球横径、球尖距、球后软组织周长、面积及体积的变化;测定治疗前后促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)及甲状腺体积的变化;统计不良反应发生情况。结果:糖皮质激素组、环磷酰胺组患者疗效均优于奥曲肽组(P<0.05),但糖皮质激素组与环磷酰胺组疗效无差异(P>0.05)。治疗12wk,三组患者眼球突出度、CAS评分均降低(P<0.05),视力及自觉复视情况均改善,球尖距、球后软组织周长、面积及体积、TRAb、TPOAb、甲状腺体积均降低(P<0.05),且糖皮质激素组、环磷酰胺组患者眼球突出度、CAS评分、球尖距、球后软组织周长、面积及体积、TRAb、TPOAb、甲状腺体积均低于奥曲肽组(P<0.05),但糖皮质激素组、环磷酰胺组组间以上参数比较均无差异(P>0.05)。治疗期间,糖皮质激素组体质量增加及总不良反应发生率均高于环磷酰胺组与奥曲肽组(P<0.0167),但环磷酰胺组、奥曲肽组组间不良反应发生率无差异(P>0.0167)。结论:糖皮质激素、环磷酰胺治疗GO整体疗效优于奥曲肽,对眼征及甲状腺相关病变改善优于奥曲肽,但环磷酰胺治疗不良反应较糖皮质激素低,安全性更高,可作为GO治疗的首选。     

生长抑素治疗甲状腺相关性眼病的疗效分析

目的 探讨生长抑素(奥曲肽)治疗甲状腺相关性眼病的疗效.方法 将42例甲状腺相关性眼病(TAO)患者随机分为A、B二组,每组21例.A组眶内注射生长抑素(奥曲肽)100μg,;B组眶内注射地塞米松5mg.各组均每2周注射1次,连续注射6次.结果 (1)眼球突出度:A组治疗后3个月较治疗前明显减轻(P<0.05);B组治疗后3个月较治疗前无明显减轻(P＞0.05);(2)眼球运动障碍及复视例数:A组治疗后(23.8%)比治疗前(57.1%)明显减少(P<0.05);B组治疗后(33.3%)比治疗前(52.4%)无明显减少(P＞0.05).结论 眶内注射生长抑素治疗甲状腺相关性眼病是有效和安全的.     

球后注射曲安奈德联合眶部放射治疗中度甲状腺相关性眼病疗效观察

目的:探讨球后注射曲安奈德联合眶部放射治疗中度甲状腺相关性眼病的疗效。方法:本院治疗的中度甲状腺相关性眼病患者32例60眼,随机分为联合治疗组和对照组:联合治疗组给予球后注射曲安奈德10mg联合眶部放射;对照组给予球后注射曲安奈德10mg。分别测量两组患者治疗前后的眼球突出度及睑裂宽度,观察眼球运动及自觉症状,根据Donaldson等的分级评分系统评估治疗效果,并行眼眶CT检查眼外肌和眶周组织水肿改善情况。结果:联合治疗组治疗前后眼球突出度、睑裂宽度及眼病分值差异有显著性(P<0.05),对照组治疗前后眼球突出度差异有显著性(P<0.05),但睑裂宽度及眼病分值差异无显著性(P>0.05),联合治疗组眼球突出度、睑裂宽度及眼病分值的降低值较对照组明显,两者差异有显著性(P<0.05)。两组患者复视及眼球运动都有改善,CT检查眼外肌和眶周组织水肿都有所改善,但联合治疗组改善率为81%,治疗组改善率为71%。结论:球后注射曲安奈德联合眶部放射是治疗中度甲状腺相关性眼病的一种有效方法,治疗效果优于单用球后注射曲安奈德。     

曲安奈德球后注射治疗甲状腺相关眼病60例

目的探讨球后注射曲安奈德治疗甲状腺相关眼病（thyroid associated ophthalmopathy,TAO）的临床效果。方法选择60例（80眼）TAO患者,球后注射曲安奈德,对比观察手术前后患者自觉症状、眼部体征、无复视面积及眼肌大小。结果治疗后患者平均眼球突出度下降（3．9±0．2）mm,手术前后差异有统计学意义;无复视面积增幅（119．6±20．1）mm^2,肌肉厚度减幅（0．4±0．1）mm,差异均有统计学意义。畏光、流泪、异物感等刺激症状消失或明显减轻61眼,有效率76．25％;眼睑肿胀消失42眼,由中度转为轻度33眼,有效率97．40％;结膜充血消失70眼,8眼无改变,有效率89．74％。所有病例无严重并发症发生。结论球后注射曲安奈德可使眼球突出度明显下降,有效减轻患者的复视及眼外肌大小。（中国眼耳鼻喉科杂志,2009,9：105—106）     

99Tc-亚甲基二膦酸盐联合糖皮质激素治疗Graves 眼病的疗效和安全性

目的：：评价99 Tc-亚甲基二膦酸盐(99 Tc-MDP)联合糖皮质激素治疗Graves 眼病的临床疗效和安全性。方法：Graves眼病患者96例144眼随机分为对照组和试验组,对照组应用甲基强的松龙针冲击治疗,间歇期口服强的松片,试验组静脉滴注99 Tc-MDP针剂,同时应用甲基强的松龙针和强的松治疗,对比两组患者的疗效和安全性。结果：两组Graves眼病患者的临床症状均有好转,在突眼度方面,试验组有效率高于对照组,差异具有统计学意义( P<0.05);在Graves眼病活动性方面均得到了较好的改善,两组患者比较无统计学差异(P>0.05)。试验组未出现与99 Tc-MDP相关的严重不良反应。结论：99 Tc-MDP联合糖皮质激素治疗Graves 眼病具有较好的疗效,尤其在改善突眼度方面效果好,副反应少,值得临床推广。     

糖皮质激素冲击疗法治疗重症甲状腺相关眼病26例

目的临床观察糖皮质激素冲击疗法治疗重症甲状腺相关眼病(thyroidassociatedophthalmopathy,TAO)患者的疗效。方法静脉点滴甲基强的松龙1.0g/d,连续3d后改为静脉点滴甲基强的松龙0.5g/d,连续2d后改为清晨顿服强的松龙40mg/d。每2周递减5mg,同时每月眶周注射康尼克通-A40mg 地塞米松5mg,连续3次。结果26例重症TAO患者临床表现有明显改善,有效率为85%。疗效与有无甲状腺功能异常无统计学意义,并且疗效与发病时间的长短有明显相关性。结论糖皮质激素冲击疗法治疗重症TAO有明显疗效。     

甲基强的松龙冲击治疗甲状腺相关眼病的荟萃分析

目的 系统评价大剂量甲强龙冲击治疗甲状腺相关眼病的临床效果.设计 荟萃分析研究.研究对象 发表关于甲基强的松龙冲击治疗甲状腺相关眼病的文献.方法 通过计算机和手工检索,获得以往发表的相关文献.按照选择标准选取合适的随机对照临床试验进行Meta分析.按照意向性分析原则对纳入文献的相关资料进行提取摘录.以治疗有效率为临床治疗终点,以相对危险度(RR)来判定疗效.主要指标 治疗有效率及相对危险度.结果 总计有6项临床研究纳入Meta分析.甲基强的松龙冲击与安慰剂相比的RR(95%CI)为7.50(1.14,49.26),与眼眶减压术相比的RR(95%CI)为3.33(0.51,21.89).与口服糖皮质激素相比的合并RB(95%CI)为1.50(1.12,2.00).甲基强的松龙冲击联合眼眶局部放疗与口服糖皮质激素联合眼眶局部放疗相比的合并RR(95%CI)为1.42(1.11,1.81).结论 大剂量甲基强的松龙冲击治疗是甲状腺相关眼病的有效治疗方案,联合应用眼眶局部放疗可提高疗效.     

99Tcm-生长抑素类似物眼眶显像在药物治疗甲状腺眼病疗效观察中的应用价值

目的 探讨99Tcm-生长抑素类似物眼眶显像在球周注射奥曲肽或曲氨萘德治疗甲状腺相关性眼病(TAO)疗效观察中的应用价值.方法 通过临床活动度评分(CAS)标准和99Tcm-生长抑素类似物眼眶显像确定TAO临床活动性.将处于炎症活动期(CAS≥3分且99Tcm-生长抑素类似物眼眶显像呈阳性)TAO患者(71例)分为两组:奥曲肽治疗组21例,曲氨萘德治疗组50例;并选取正常志愿者(12名)作为对照组.分别在治疗前后,对治疗组和对照组所有受试对象行99Tcm-生长抑素类似物眼眶显像和CAS评分,计算其眼眶生长抑素类似物摄取比值(UR);对试验组受试对象的眼球突出度、TAO相关眼征(von-Graeve征、Dalrymple征和Eniroth征)、眼压及其它与药物相关的不良反应进行观察记录,对试验数据进行统计学分析.结果 治疗前,治疗组患者UR值显著高于对照组(F=22.517,P＜0.001),奥曲肽组与曲氨奈德组间差异无统计学意义(P＞0.05);治疗后,治疗组患者UR值均显著降低(t奥=5.31,P奥＜0.01;t曲=4.34,P曲＜0.01),接近正常水平(P＞0.05);与之相似,治疗组患者CAS值也显著低于治疗前(t奥=4.21,P奥＜0.0l;t曲=3.89,P曲＜0.01).治疗组患者眼球突出症状明显缓解(眼球突出度后退值:奥曲肽组3.48mm,曲氨奈德组2.61mm).治疗前后,奥曲肽组患者von-Graeve征和Dalrymple征阳性率差异无统计学意义(P＞0.05),而Eniroth征阳性率显著低于治疗前(P＜0.01);而曲氨奈德组患者治疗后von-Graeve 征、Dalrymple征和Eniroth征阳性率均显著低于治疗前(χ2von-Graeve=32.19,P＜0.01;χ2Dalrymple=41.36,P＜0.01;χ2Eniroth=26.27,P＜0.01).治疗组患者治疗前后眼压值无显著改变(P＞0.05),但曲氨奈德组不良反应发生率显著高于奥曲肽组(χ2=5.396,P＜0.05).结论 99Tcm-生长抑素类似物眼眶显像对确定TAO临床活动性具有重要的意义,显像阳性的患者活动性高,应用奥曲肽或曲氨萘德局部治疗效果好,患者突眼症状均显著缓解.其中,曲氨萘德的眼征转阴率优于奥曲肽,但其不良反应发生率也高于奥曲肽.两药对眼压均无明显影响.     

Orbital steroid injection versus oral steroid therapy in management of thyroid‐related ophthalmopathy

Background: The aim of this study was to evaluate the efficacy, safety and complications of orbital steroid injection versus oral steroid therapy in the management of thyroid‐related ophthalmopathy. Methods: A total of 29 patients suffering from thyroid ophthalmopathy were included in this study. Patients were randomized into two groups: group I included 15 patients treated with oral prednisolone and group II included 14 patients treated with peribulbar triamcinolone orbital injection. Only 12 patients in both groups (16 female and 8 male) completed the study. Results: Both groups showed improvement in symptoms and in clinical evidence of inflammation with improvement of eye movement and proptosis in most cases. Mean exophthalmometry value before treatment was 22.6 ± 1.98 mm that decreased to 18.6 ± 0.996 mm in group I, compared with 23 ± 1.86 mm that decreased to 19.08 ± 1.16 mm in group II. Mean initial clinical activity score was 4.75 ± 1.2 and 5 ± 1.3 for group I and group II before treatment, respectively, which dropped to 0.83 ± 1.2 and 0.83 ± 1.02, 6 months after treatment, respectively. There was no change in the best‐corrected visual acuity in both groups. There was an increase in body weight, blood sugar, blood pressure and gastritis in group I in 66.7%, 33.3%, 50% and 75%, respectively, compared with 0%, 0%, 8.3% and 8.3% in group II. No adverse local side effects were observed in group II. Conclusion: Orbital steroid injection for thyroid‐related ophthalmopathy is effective and safe. It eliminates the adverse reactions associated with oral corticosteroid use.     

The influence of treatment of progressive edematous infiltrative ophthalmopathy on intraocular pressure

PURPOSE: To evaluate the influence of systemic steroid therapy and retrobulbar irradiation on intraocular pressure (IOP) in patients with infiltrative--oedematous Graves' ophthalmopathy. MATERIAL AND METHODS: We examined 76 patients divided into 3 groups: I--treated by irradiation only (15 patients), II--treated by irradiation and oral prednisone therapy (26 patients), III--treated by irradiation and intravenous methylprednisolone pulse therapy (35 cases). All patients underwent full ophthalmological examination (including IOP measurement, perimetry and gonioscopy) before, during, immediately after and 2-20 months after treatment. RESULTS: Increased IOP (21-31 mm Hg) was observed in 54 patients (71%) before treatment. The iridocorneal angle was open in all eyes. Changes in perimetry were not characteristic for glaucoma. IOP was higher in patients with more severe ophthalmopathy. We recorded transient increase of IOP during treatment in only 3 patients. Increased IOP immediately after therapy was observed in 16 patients with severe symptoms and signs of ophthalmopathy: in group I--4/15 (27%), in group II--4/26 (15%), in group III--8/35 (23%). Higher IOP was recorded in 10 patients two to twenty months after completion of treatment: from group I--4/15 (27%), from group II--1/26 (4%) and from group III--5/35 (14%). In 6 of these 10 persons we observed recurrence of ophthalmopathy, in 4 patients higher IOP was the only deviation, they needed local therapy. The mean values of IOP were lower in patients treated by steroid therapy in comparison to patients treated by irradiation only. The most rapid improvement of clinical status was observed in patients treated by methylprednisolone pulse therapy. CONCLUSIONS: The increase of IOP in patients with Graves' ophthalmopathy correlates with severity and duration of eye disease. Systemic steroid therapy is more efficient in reduction of IOP than irradiation of the retrobulbar tissue. Our results suggest that combined therapy is a preferable method of treatment of progressive ophthalmopathy, including cases with increased intraocular pressure.     

深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病

目的：探究深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病的临床治疗效果及安全性。

方法：分析我科既往住院患者病历,纳入2019-01/2020-05在我科住院的符合纳入标准的甲状腺相关性眼病患者17例。所有患者均在全身麻醉下行深外侧壁联合内侧壁眼眶减压术,比较患者术前术后的视力、暴露性角膜炎恢复情况、突眼度、眼压以及并发症情况。

结果：所纳入研究的对象中,有甲状腺相关眼病视神经病变(DON)8例9眼,术前的最佳矫正视力0.78±0.15,术后1mo 0.36±0.12,与术前视力相比有差异(P<0.01),术后6mo 0.38±0.12,与术后1mo无差异(P=0.594)。术前眼球突出度23.75±2.55mm,术后1mo为14.85±1.53mm,与术前突眼度相比有差异(P<0.01),术后6mo为14.60±1.64mm,与术后1mo基本保持稳定(P=0.658)。术前眼压25.56±3.23mmHg,术后1mo为18.42±2.35mmHg,与术前相比有差异(P<0.01),术后6mo眼压降至15.82±2.57mmHg,与术后1mo眼压相比有差异(P<0.01)。术前有暴露性角膜炎6例6眼,术后1mo有4眼好转,2眼治愈,术后6mo 6眼全部治愈。术后患者复视情况均有不同程度减轻,并有部分患者复视症状在此后6mo持续好转,未出现其他严重并发症。

结论：深外侧壁联合内侧壁眼眶减压术可以有效地改善眼突,对DON及暴露性角膜炎等严重并发症也有良好的疗效,并发症少,是治疗严重甲状腺相关性眼病的有效手术方案。     

Oktreotidszintigraphie zur Diagnose der aktiven endokrinen Orbitopathie

PURPOSE: In this study the diagnostic accuracy of orbital octreotide uptake in patients with presumed active Grave's ophthalmopathy (GO) was evaluated. PATIENTS AND METHODS: A prospective study of 23 patients suffering from GO was carried out. Single photon emission computed tomography (SPECT) images were obtained 4 h after iv injection of 3 mCi 111 indium octreotide. The results were correlated with the patients clinical state during a follow-up of 17.5+/-6 months. RESULTS: Octreotide scintigraphy was positive in 15 and negative in 8 cases, 12 patients with positive octreotide scintigraphy underwent immunosuppressive treatment and showed a clinically positive response with regression of symptoms. In three cases the patients refused immunosuppressive treatment. Patients with negative pathologic orbital octreotide uptake did not undergo any treatment. CONCLUSION: Octreotide scintigraphy is a useful tool to determine the activity state of Graves' ophthalmopathy. Since Graves' ophthalmopathy must be treated in the active phase, octreotide scintigraphy should be performed in subacute cases to facilitate the indications for immunosuppressive treatment.     

曲安奈德联合577nm激光治疗黄斑囊样水肿临床研究

目的:评价球后注射曲安奈德(triamcinolone acetonide,TA)联合577nm激光黄斑区格栅样光凝治疗黄斑囊样水肿的治疗效果。方法:对58例66眼不同原因导致的黄斑囊样水肿患者,给予球后注射曲安奈德联合577nm激光黄斑部格栅样光凝治疗,观察所有病例激光后第1wk;1,3mo最佳矫正视力、黄斑厚度、眼底及眼压情况。结果:所有66眼中,光相干断层成像技术及眼底荧光造影检查示黄斑囊样水肿均部分或完全消退,54眼(82%)视力好转,12眼视力不变。结论:对于黄斑囊样水肿,球后注射曲安奈德联合577nm激光黄斑部格栅样光凝,治疗效果好,操作简单,并发症少。     

小剂量泼尼松治疗Graves眼病的疗效及影响因素

目的：分析口服小剂量泼尼松治疗Graves眼病的疗效及影响因素,指导临床优化治疗方案。

方法：2010-01/2012-12来自中山一院眼科和核医学科确诊的Graves眼病患者118例,其中男37例,女81例,年龄14～67(平均35.4±12.2)岁,每天口服15mg泼尼松,连服3～6mo。好转定义为治疗后突眼严重性分级减低和/或突眼由活动变为非活动。于治疗第6mo末比较治疗前后突眼的变化并对疗效的影响因素进行分析。

结果：经泼尼松治疗后,58.5%的 Graves眼病患者突眼好转; 其中72.6% 的活动性突眼患者突眼好转,而非活动性突眼患者仅23.5% 好转,两组差异有统计学意义(P<0.01)。活动性突眼患者血清TRAb高于非活动性患者(P<0.01)。轻中重度三组突眼的患者中,突眼越轻的患者疗效越好(P<0.01)。突眼病程越长,突眼越严重(P<0.01)。治疗期间甲状腺功能状态无论过高或过低,均可加重患者突眼(P<0.01)。

结论：每天口服15mg泼尼松,持续3～6mo对活动性Graves突眼的改善明显优于非活动性突眼。病程越短的患者突眼越轻,而突眼越轻治疗效果越好,故发现突眼需及早治疗,同时力争把甲状腺功能控制在正常范围,减少突眼的加重。