Comparative evaluation of peribulbar triamcinolone acetonide and intravenous methylprednisolone in thyroid eye disease

Ayushi Agarwal, Sushil Kumar, Ruchi Goel, Akash Raut, Samreen Khanam, Mohit Chhabra

Meeting:  2022 RANZCO


Date:      -

Session Title: FREE PAPERS – Oculoplastic/Ocular Oncology

Session Time:      -

Purpose: To compare the efficacy and safety of Intrave- nous Methylprednisolone (IVMP) and peribulbar Triam- cinolone Acetonide (p-TA) in the treatment of active thyroid eye disease.

Method: Randomised controlled trial. Twenty adult patients (34 eyes) with moderate-severe active thyroid eye disease were randomised into two equal groups over a period of one year. Group A received four doses of two-weekly p-TA injection and Group B received IVMP, 500 mg weekly for six weeks followed by 250 mg weekly for another six weeks. Change in Clinical Activity Score, extraocular muscle thickness on computed tomography, diplopia, lid retraction, ocular motility and exophthalmos were assessed at six-months post-treatment.

Results: Mean Clinical Activity Score of 4.9 ± 0.88 and 5 ± 1.15 decreased to 2.1 ± 1.29 and 1.7 ± 1.06 in Group A (p = 0.005), and B (p = 0.005) respectively. The difference between groups was statistically not significant (p = 0.348). EOM thickness decreased in both groups post-intervention, Group A (mean decrease in inferior rectus [IR] 0.69 ± 0.69, p = 0.004; superior rectus [SR] 1.49 ± 1.34, p = 0.002; medial rectus [MR] 0.88 ± 0.54, p = 0.0003) and Group B (mean decrease in IR, 1.21 ± 0.61, p = 0.003; SR 1.1 ± 0.86, p = 0.005; MR 1.14 ± 0.7, p = 0.003). The intergroup difference for IR, SR and MR (p = 0.065, 0.84 and 0.38 respec- tively) was not significant. Improvement in diplopia, exophthalmos, ocular motility and lid retraction was observed in both groups. Side effects such as gastritis (n = 1), pedal edema (n = 1) and amenorrhea (n = 1) were seen in group B whereas none were observed in Group A.

Conclusion: p-TA injections are as efficacious as IVMP with a better safety profile.