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Peri-levator Betamethasone Versus Triamcinolone Injection in Management of Thyroid Eye Disease-related Upper Eyelid Retraction Without Proptosis
Purpose: To compare the efficacy of peri-levator injection
of both betamethasone and triamcinolone in the management
of thyroid eye disease-related upper eyelid retraction without
proptosis.
Methods: This prospective, double-blind, randomized
clinical trial was conducted at Assiut University Hospital,
Upper Egypt in the period between December 2021 and October
2023. The study included 47 patients (56 eyes) and was divided
into 2 groups. In group A, 1 ml betamethasone was injected
into the peri-levator area, while in group B, 1 ml triamcinolone
was injected. The injection was repeated every month for up
to 5 injections if there was an improvement in margin reflex
distance 1 (MRD1). The injection was stopped if MRD1
reached the normal value or if 2 successive injections caused
no improvement in MRD1. The postinjection outcome was
divided into: 1) effective if MRD1 reached the normal ≤4.5 mm;
2) partially effective if MRD1 was improved but did not reach
the normal; and 3) ineffective if there was no improvement in
MRD1. The follow up ranged from 6 to 20 months.
Results: In group A, the injection was effective in 26 eyes
(92.9%) and partially effective in 2 eyes (7.1%). In group B,
the injection was effective in 17 eyes (60.7%), partially effective
in 6 eyes (21.4%), and ineffective in 5 eyes (17.9%). The mean
number of injections was significantly lower in group A than in
group B: 1.61 ± 0.50 versus 2.36 ± 1.16.
Conclusions: This study results suggest that betamethasone
is more effective with a smaller number of injections than
triamcinolone in the management of thyroid eye disease-related
upper eyelid retraction.
