ABSTRACT
@#AIM: To explore the clinical effects of Glucocorticoids, Cyclophosphamide and Octreotide in the treatment of Graves' ophthalmopathy(GO). <p>METHODS: A retrospective study was conducted. Totally 102 patients(152 eyes)with GO admitted to the hospital between June 2018 and October 2019 were divided into glucocorticoid group(33 cases, 51 eyes), cyclophosphamide group(38 cases, 59 eyes), and octreotide group(31 cases, 42 eyes)according to the treatment method. All groups received 12wk of treatment. The treatment results were comparatively analyzed. Changes in proptosis degree, diplopia, intraocular pressure and visual acuity before and after treatment were measured. Clinical activity scoring(CAS)of thyroid associated eye movements was performed. Changes in ocular axes, eyeball transverse diameter, ocular apex distance, retrobulbar perimeter, area and volume were measured by eye ultrasound. Changes in thyrotropin receptor antibody(TRAb), thyroid peroxidase antibody(TPOAb)and thyroid volume before and after treatment were determined. The incidence of adverse reactions was counted. <p>RESULTS: Compared with octreotide group, grades of curative effect of glucocorticoid group and cyclophosphamide group were better(<i>P</i><0.05), but there was no statistically significant difference between glucocorticoid group and cyclophosphamide group(<i>P</i>>0.05). After 12wk of treatment, the proptosis degree and CAS scores of the three groups were decreased(<i>P</i><0.05), visual acuity and conscious diplopia were improved, ocular apex distance, retrobulbar perimeter, area and volume, TRAb, TPOAb and thyroid volume were decreased(<i>P</i><0.05). The proptosis degree, CAS scores, ocular apex distance, retrobulbar perimeter, area and volume, TRAb, TPOAb and thyroid volume of glucocorticoid group and cyclophosphamide group were smaller than those of octreotide group(<i>P</i><0.05), without statistically significant differences between glucocorticoid group and cyclophosphamide group(<i>P</i>>0.05). During treatment, the incidences of weight gain and the total incidence of adverse reactions were higher in glucocorticoid group than in cyclophosphamide group and octreotide group(<i>P</i><0.0167), but there were no statistically significant differences between cyclophosphamide group and octreotide group(<i>P</i>>0.0167). <p>CONCLUSION:Glucocorticoids and cyclophosphamide are better than octreotide in the treatment of GO, which can better improve ocular signs and thyroid-related lesions. Additionally, the incidence of adverse reactions caused by cyclophosphamide is lower than glucocorticoids, and its safety is higher. Therefore, cyclophosphamide is the first choice for treating GO.
ABSTRACT
@#AIM: To explore the clinical efficacy and prognosis of glucocorticoid combined with surgical method for TAO-related upper eyelid retraction. <p>METHODS: A total of 96 patients(146 eyes)with upper eyelid retraction who were admitted to the plastic surgery clinic and ward of our hospital from February 2014 to July 2018 were selected. According to different treatment methods, the patients were divided into GI group: 72 patients with TAO-related upper eyelid retraction treated with glucocorticoids; 72 patients with GS group: 48 patients with TAO-related upper eyelid retraction treated with glucocorticoid combined with conjunctival approach. After treatment, the upper eyelid muscle strength, the treatment effect, the height of the eyelid fissure, and the actual double eyelid width were compared between the two groups of patients.<p>RESULTS: After treatment, the patients in GI group had significant treatment effects in 32 people and 47 eyes, and the patients in the GS group had significant treatment effects in 16 and 25 eyes. The patients in the GS group had significant treatment effects in 46 cases and 71 eyes, and there were no significant treatment effects in 2 people and 3 eyes. Compared with the GS group, the treatment effect of the GS group was significantly higher than that of the GI group(<i>P</i><0.05). There was no significant difference between GS group and GI group(<i>P</i>>0.05). According to the table, before treatment, the height of the eyelid fissures in the GI group and the GS group were 11.25±1.85 and 11.31±1.46mm, and the data in the two groups were similar(<i>P</i>>0.05). The height of the eyelid fissures was 10.14±1.23mm, 3mo after treatment was 8.52±1.01mm. Compared with the GI group, the recovery of blepharoplasty was better in the GS group than in the GI group(<i>P</i><0.05). According to the table, before treatment, the upper eyelid muscle strength of the patients in the GI group and the GS group were 15.34±2.13 and 15.26±1.78mm, the data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the upper eyelid muscle strength was 15.64±1.34, 14.36±1.56mm. There was no significant difference in upper eyelid muscle between the GI group and the GS group(<i>P</i>>0.05). The results showed that before treatment, the patients with GI group and GS group actually had a double eyelid width of 5.12±1.64 and 5.16±1.48mm. The data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the double eyelid was actually The widths were 7.67±2.95 and 8.49±2.39mm, respectively. Compared with the GI group, the GI group had a better change in the double eyelid width than the GI group(<i>P</i><0.05). <p>CONCLUSION: Glucocorticoid combined with conjunctival approach Müller myectomy is better for patients with upper eyelid retraction, which can significantly improve the height of the eyelid fissure and the width of the double eyelid.