Pilot study to assess the efficiency and safety of the parabulbar triamcinolone for the treatment of moderate to severe Graves Ophthalmopathy assessed through STIR magnetic resonance imaging

ORTIZ BASSO T; PREMOLI J; VIGO RL

Conferencia; 2016 ARVO Imaging in the Eye Conference; 2016

Purpose: The efficiency of the parabulbar triamcinolone for treatingthe Thyroid ? Associated Ophthalmopathy (TAO) is a controversialissue. We performed a quasi ? experimental prospective study toassess if the parabulbar triamcinolone is effective and safe so as todecrease the orbital inflammation in patients presenting moderate tosevere TAO.Methods: It was carried out on patients who suffered from amoderate to severe active Thyroid ? Associated Ophthalmopathy.Through orbital STIR magnetic resonance imaging it was assessedwhether the Signal Intensity Ratio (SIR) of the extraocular musclesdecreased after a treatment with parabulbar acetonide triamcinolone.Furthermore, the Clinical Activity Score (CAS) was analyzedtogether with the exophthalmometry, before and after the treatment.Criteria to exclude patients from the treatment were applied to thosesuffering from orbitopathy of other ethiology, who had undergonesurgery during the 6 previous months, those treated with local orsystemic corticosteroids during the 6 previous months. A T ? test forpaired data was used for statistical analysis.Results: There were included 15 patients and 28 orbits for theanalysis. The average age was 42 years (SD 15,47) and 66% (n10)were women.The average SIR for the inferior rectus was 4.07 (SD 1.4) beforethe treatment and 2.67 (SD 0.93) (p 0.0003) after it; in the case ofthe superior rectus the average SIR was 3.57 (SD 0.86) and 2.8 (SD0.44) (p 0.0002) after the treatment; in the case of the external rectusthat value was 3.65 (SD 0.76) before the treatment and 2.8 (SD 0.4)(p 0,0002) after the treatment; and finally, for the internal rectus theaverage SIR was 3.93 (SD 1.1) before the treatment and 3.1 (SD0.58) (p 0.0026) after the treatment.No patient presented local or systemic complications after thetreatment.Conclusions: The treatment with parabulbar triamcinolone iseffective and safe do decrease SIR in patients presenting moderate tosevere thyroid-associated ophthalmopathy.Although further studies are necessary to compare the efficiencyand safety of local and systemic corticosteroids applying thistechnique, they can be effectively replaced when the risk of systemiccorticosteroids are greater than the benefits.