Purpose: To describe visual morbidity in thyroid orbitopathy in Asian Indians and the factors influencing its onset. Methods: A retrospective chart review was performed for patients with thyroid related orbitopathy seen between May 2014 and April 2019. Three hundred and one patients were included in the study. Relevant history, clinical findings, investigations, and treatment were documented. Results: Nineteen percent of patients had at least 1 visual morbidity feature such as compressive optic neuropathy, exposure keratopathy or diplopia, requiring intravenous glucocorticoid. Male gender, older age, and diabetes were the significant risk factors for high visual morbidity (all P < 0.05). Systemic thyroid status, degree of proptosis, and duration of disease were not significant. Average dose of intravenous glucocorticoid needed was 3.8 g; 24 (7.9%) patients required orbital decompression, and 13 (4.3%) needed eyelid surgery. At the last follow-up, 97% of patients had vision 6/12 or better in both eyes. Conclusion: There is significant visual morbidity found in Indian patients with TED, even with moderate proptosis and systemic control of thyroid status. This is the first set of data on the subject.
Use of 5-Fluorouracil Injections in Traumatic Cicatricial Malposition of EyelidsS carring in the eyelid and periocular regions has both cosmetic and functional implications. Free and unrestricted movement of the eyelids is imperative for opening and closing of the eye and for protection of the ocular surface.Among the nonsurgical modalities of scar treatment, the antineoplastic drug 5-fluorouracil has been used widely. 1 We share our experience with its use in posttraumatic cicatrizing eyelid malposition. All the patients had undergone primary treatment for eyelid trauma elsewhere. The patients presented with lagophthalmos (Fig. 1), ptosis, or cicatricial ectropion. [See Figure, Supplemental Digital Content 1, which shows a patient with ptosis caused by cicatricial tethering of eyelid at the lateral orbital rim. Photograph taken 4 weeks after the injury. Lateral view shows the scar (above) and the resolution of ptosis 4 weeks after the last injection. A total of 105 mg of 5-fluorouracil was injected in three sittings. The patient did not desire surgery. Lateral view after 5-fluorouracil injection shows improvement in the scar (below), http://links.lww.com/PRS/ F327.] Twelve patients (mean age, 38.3 years; SD, 12.6 years; nine male and three female) received injections before any surgical intervention at our clinic.Measurements and clinical photographs were taken before and after injection. We continued the injections every 3 to 4 weeks or until improvement plateaued. The earliest injections were at 4 weeks, with a mean delay of 3.08 months.All cases were performed under topical anesthesia with a mixture of lignocaine 2.5% W/W and prilocaine 2.5% W/W (Prilox cream; Neon Laboratories, Bangalore, India). We injected 5-fluorouracil 50 mg/ ml (Fluracil; Zydus Cadila, Ahmedabad, India) with a 26-gauge or 30-gauge needle in 0.1-ml aliquots injected at intervals of 5 mm into and around the scar. Traction sutures were applied to facilitate lengthening of the scar.The mean interval from injury to first presentation at our clinic was 3.08 months (range, 1 to 14 months). The mean dose of injections required was 54.3 mg (range, 15 to 105 mg) in one to four sittings. Objective improvement was seen in 11 of 12 patients (91.6 percent) (Fig. 1). [See Figure, Supplemental Digital Content 1, http://links.lww.com/PRS/F327.] Reconstructive surgery could be avoided in six of 12 patients (50 percent). Patients with anterior lamellar skin deficiency required surgery. Pain and burning sensation were reported after the first injections in the first two patients. Oral paracetamol 650 mg immediately after injection kept the patients comfortable. No patient experienced 5-fluorouracil toxicity on the ocular surface. No patient showed wound dehiscence or skin ulceration, known adverse events. 2 channels for sharing in-depth clinical experiences among plastic surgeons.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.