• Neuro-Ophthalmology/Orbit

    This randomized study compared the efficacy, safety and complications of orbital steroid injection with oral steroid therapy for managing thyroid-related ophthalmopathy (TRO). This is believed to be the first randomized clinical trial to address this issue. The authors found that while the efficacy of the treatments was similar, patients who received orbital steroid injections experienced fewer systemic side effects.

    The authors randomized 29 patients with TRO to treatment with oral prednisolone (60 to 100 mg/day) or injection of 20 mg of peribulbar triamcinolone acetonide (Kenacort A, 40 mg/mL) in each orbit weekly for four consecutive weeks. Twelve patients in each group completed the study.

    Both groups showed improvement in symptoms and in clinical evidence of inflammation, with improvement of eye movement and proptosis in most cases. The mean exophthalmometry value in the oral treatment group decreased from 22.6 ± 1.98 mm before treatment to 18.6 ± 0.996 mm six months after treatment. This compared with a decrease from 23 ± 1.86 mm to 19.08 ± 1.16 mm in the orbital injection group. The mean clinical activity score dropped from 4.75 ± 1.2 to 0.83 ± 1.2 in the oral treatment group and from 5 ± 1.3 to 0.83 ± 1.02 in the injection group. BCVA did not change in either group. However, body weight, blood sugar, blood pressure and gastritis increased by 66.7 percent, 33.3 percent, 50 percent and 75 percent, respectively, in the oral treatment group compared with 0 percent, 0 percent, 8.3 percent and 8.3 percent, respectively, in the orbital injection group. No adverse local side effects were observed in the injection group.

    The authors conclude that orbital steroid injection for TRO is effective and safe, and eliminates the adverse reactions associated with oral corticosteroid use.