甲状腺眼症の下直筋肥大に対するトリアムシノロンアセトニドテノン囊下注射の治療成績

Effect of sub-Tenon's triamcinolone acetonide injection for hypertrophic inferior rectus muscle in thyroid ophthalmopathy

要約　目的：甲状腺眼症の下直筋肥大に対するトリアムシノロンアセトニドテノン囊下注射（STTA）の治療成績を報告する。対象と方法：下直筋肥大にSTTAを施行し6か月間経過観察した78例78眼，年齢29～81歳（平均51歳）についてSTTA前後のMRIで下直筋断面積と信号強度比（下直筋/大脳白質）を比較し，年齢，性別，罹病期間，喫煙，甲状腺刺激抗体（TSAb），追加治療の有無，合併症を検討した。結果：STTA後の下直筋断面積とT2-SIRは有意に減少した。T2-SIR非改善群はTSAbが有意に高値で，追加治療あり群（44眼）は注射前T2-SIRが有意に高かった。結論：甲状腺眼症の下直筋肥大に対してSTTAは安全で有効な治療法であった。

Abstract.　Purpose：To report the effect of sub-Tenon's triamcinolone acetonide injection for hypertrophic inferior rectus muscle in thyroid ophthalmopathy. Cases and Method：This study was made on 78 eyes of 78 cases who received sub-Tenon's triamcinolone acetonide injection for hypertrophic inferior rectus muscle in thyroid ophthalmopathy. The cases were aged from 29 to 81 years, average 51 years. Magnetic resonance imaging（MRI）was used to quantitate the cross-sectional area of inferior rectus muscle and T2-signal intensity ratio. Cases were evaluated regarding thyroid-stimulating antibody, diplopia and complications. They were followed up for 6 months. Results：The treatment was followed by decrease in the cross-sectional area of inferior rectus muscle and T2-signal intensity ratio（p＜0.01）. Cases who failed to respond to treatment, showed higher levels of thyroid-stimulating antibody. Cases who needed additional treatment showed higher T2-signal intensity ratio（p＜0.01）. Conclusion：Sub-Tenon's triamcinolone acetonide injection was effective for hypertrophic inferior rectus muscle in thyroid ophthalmopathy.