Abstract:  Objective To study the efficacy and complication of triamcinolone (TA) periglobal and upper fornix injection for moderate to severe active thyroid associated ophthalmopathy (TAO).  Design Retrospective case series. Participants 34 cases (60 eyes) of patients with moderate to severe TAO. Methods The patient's medical records were reviewed. All patients received a periobital injection of  TA (20-40 mg). The patients whose upper eyelid retraction ≥2 mm were given 20 mg TA into the fornix of the upper eyelid. Follow-up visit at 1 week after the first treatment, repeat the injection monthly if the symptoms were improved. When the upper eyelid position dropped to normal or consistent with the contralateral eye, the eyelid and conjunctival hyperemia and edema were stopped, the patients were observed and followed up for at least 3 months. The mean follow-up was 9.12±5.28 months. Main Outcome Measures Clinical activity score (CAS), thyroid eye disease quality of life scale (TED-QOL), marginal reflex distance(MRD1), exophthalmos, LogMAR best corrected visual acuity (BCVA), intraocular pressure, B ultrasonic extraocular muscle diameter. Results Before treatment and in the last follow-up, the CAS scores were (3.79±0.81) and (1.29±0.68)  respectively (P=0.000). The TED-QOL scale scores were (17.85±2.80) and (10.18±3.02) respectively (P=0.000). The MRD1 was (6.29±0.68) and (4.56±0.71) respectively (P=0.000). The degree of exophthalmos was (18.20±2.77)mm  and (17.65±2.90) mm respectively (P=0.000). The diameters of the superior, inferior, internal and external rectus muscles were (2.34±0.67, 3.62±1.06, 3.06±0.67, 2.71±0.79)mm, (2.15±0.50, 3.30±0.99, 2.81±0.61, 2.51±0.61)mm, respectively (all P<0.05). The BCVA (LogMAR) was (4.99±0.12) and (4.99±0.16) (P=0.289) respectively. Intraocular pressure was (16.65±2.91)mmHg and (16.78±4.30)mmHg respectively (P=0.772). The difference in the degree of upper eyelid retraction between periglobal and upper fornix injection and single periglobal injection was (1.15±0.38) mm and (2.31±0.48)mm respectively (P=0.000). The difference before and after treatment of exophthalmos between the two groups was (-0.69±0.75) mm and (-0.84±1.28)mm respectively (P=0.712). The difference before and after treatment of upper, lower, internal and external rectus muscles in the two groups were (0.22±0.52, 0.28±0.49)mm, (0.32±0.56, 0.51±0.76)mm, (0.35±0.40, 0.34±0.49)mm, and (0.23±0.56, 0.47±0.84)mm, respectively (all P>0.05). Intraocular pressure of 9/60 eyes (15%) had increased >21 mmHg after treatment. Menstrual changes were observed in 2 cases. Conclusions Periorbital injection of 40 mg TA can effectively reduce the orbital inflammation of TAO in active stage. The improvement of upper eyelid retraction in periglobal combined with upper fornix injection was more obvious than that of single periglobal injection. At the same time, the complications such as increased intraocular pressure should be paid attention. (Ophthalmol CHN, 2020, 29: 260-265)

Key words:  thyroid-associated ophthalmopathy/treatment, triamcinolone