两种方法治疗甲状腺相关眼病上睑退缩的效果观察  

Observation on the efficacy of two methods for the treatment of upper eyelid retraction in thyroid-associated ophthalmopathy

作　　者：黎冬平[1] 吕航 王育红[1] Li Dongping;Lyu Hang;Wang Yuhong(Hankou Hospital of Wuhan Aier Eye Hospital,Wuhan 430000,China)

机构地区：[1]武汉爱尔眼科医院汉口医院,武汉430000

出　　处：《中华眼外伤职业眼病杂志》2020年第12期887-891,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：武汉市卫生和计划生育委员会科研基金(WXl8D13);爱尔眼科医院集团科研基金(AFQl710DI)。

摘　　要：目的观察曲安奈德球旁注射与A型肉毒素局部注射治疗甲状腺相关眼病单眼轻度上睑退缩的疗效.方法前瞻性研究.汉口爱尔眼科医院2015年6月至2018年6月稳定期甲状腺相关眼病伴单眼轻度上睑退缩55例(55只眼).按随机数字表法分为两组:A组,26例,曲安奈德球旁注射,3周1次,共3次.B组,29例,A型肉毒素上睑提肌注射1次.观察两组治疗效果.结果有效率:两组治疗后1周、1个月均达100.0%,治疗后3个月A组仍为100.0%,B组为89.6%(P=0.139).退缩矫正量:治疗后1周,B组大于A组(t=3.380,P=0.001);治疗后1个月,两组相近(t=0.200,P=0.839);治疗后3个月,B组小于A组(t=-8.110,P<0.001).并发症:A组出现一过性黑朦、眶周出血及眶周凹陷各1例;B组患者复发3例.结论曲安奈德球旁注射及A型肉毒素局部注射对甲状腺相关眼病轻度上睑退缩疗效确切,前者治疗周期长,操作风险较大,但疗效较稳定;后者操作简单,治疗周期短,但易复发.Objective To observe the clinical efficacy of periorbital injection of triamcinolone acetonide and local injection of botulinum toxin A for the treatment of thyroid-associated ophthalmopathy with monocular mild upper eyelid retraction.Methods This was a prospective study.A total of 55 eyes of 55 cases of stable thyroid-associated ophthalmopathy with mild upper eyelid retraction from Jun.2015 to Jun.2018 in Hankou Aier Eye Hospital were collected and divided into two groups based on random number table method.Group A with 26 patients were injected with periorbital triamcinolone acetonide once every 3 weeks and 3 times in total.Group B with 29 patients were injected with botulinum toxin A in the palpebral levator muscle only one time.The efficacies of the two groups were observed.Results The effective rate of upper eyelid retraction was 100.0%in both groups at 1 week and 1 month after treatment.The effective rate of group A remained 100%after 3 months of treatment,and that of group B decreased to 89.6%(P=0.139).At 1 week after treatment,the amount of retraction correction in group B was larger than that in group A(t=3.380,P=0.001).At 1 month after treatment,there was no statistically significant difference between the two groups(t=0.200,P=0.839).At 3 months after treatment,the amount of retraction correction in group B was smaller than that in group A.And the difference was statistically significant(t=-8.110,P<0.001).In group A,there were 1 case of transient amaurosis,one case of periorbital hemorrhage swelling,and one case of periorbital mild depression.In group B,3 cases relapsed.Conclusion Periorbital injection of triamcinolone acetonide and local injection of botulinum toxin A have definite therapeutic efficacy for mild upper eyelid retraction in thyroid-associated ophthalmopathy.The former has longer treatment period,higher operational risk but stable efficacy.The latter has simple operation steps,short treatment period,but easy to recur.

关 键 词：GRAVES眼病 眼睑疾病 曲安奈德 眼部注射 

分 类 号：R777.1[医药卫生—眼科] R581[医药卫生—临床医学]