الفهرس | Only 14 pages are availabe for public view |
Abstract Introduction: Thyroid associated orbitopathy (TAO) is an autoimmune inflammatory condition of the orbit. Although high dose intravenous steroids are the first line for management of active TAO, about 20-30% of patients have poor response to steroids. Other immunosuppressants may be used as steroid sparing agents or in steroid resistant patients. Long term systemic administration of steroids or immunosuppressants has its adverse effects. To reduce systemic side effects, periocular injections may be used as an alternative route. Aim: To assess the efficacy and safety of periocular injections of methotrexate in the management of active TAO in comparison to periocular injections of triamcinolone. Methods: Prospective double-blind interventional randomized clinical trial in which 18 patients with bilateral active, moderate to severe TAO were randomized such that an orbit received methotrexate (7.5mg) and the contralateral orbit received triamcinolone (20mg). Each orbit received three periocular injections at 3-weeks interval. Results: In the methotrexate group, the mean CAS decreased significantly from 5.2± 0.89 at baseline to 0.9 ± 1.7 six months after last injection (p-value<0.001), mean proptosis also decreased from 25.2 ± 3.4 mm at baseline to 23.8 ± 3.7 mm at end of study (p-value=0.01). In the triamcinolone group, the mean CAS score decreased significantly from 5.1± 0.9 at baseline to 1 ± 1.7 six months after last injection (p- value<0.001), mean proptosis also decreased from 24.27 ± 3.06 mm at baseline to 23.27 ± 3.3 mm at end of study (p-value=0.049). Statistically significant decline in lid aperture and soft tissue inflammatory score in each group was observed in all visits compared to baseline. BCVA in both groups remained stationary throughout the study. A statistically significant reduction in IOP was noted in the methotrexate but not in the triamcinolone group. About 89% of patients in both groups had improvement in CAS at week 30, 33-50% of patients showed improvement in proptosis or lid aperture measurements and only 5.6% of patients had improvement in EOM function. No statistically significant difference was detected between both methotrexate and triamcinolone groups at any follow up visit. Both drugs were safe with minimal local complications and systemic adverse effects. Conclusion: Periocular methotrexate injection is as effective as periocular triamcinolone injection and represents an effective and safe modality for management of active TAO |