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Shin and Kim: Effect and Prognostic Factors of Systemic Steroid Treatment for Strabismus Associated Thyroid Ophthalmopathy
Original Article

J Korean Ophthalmol Soc 2019;60(6):575-581.

Published online: 25 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.6.575

Effect and Prognostic Factors of Systemic Steroid Treatment for Strabismus Associated Thyroid Ophthalmopathy

Gwang Rae Shin, MD1, Dae Hyun Kim, MD, PhD2

1Barun Eye Clinic, Gwangju, Korea

2Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea

Address reprint requests to Dae Hyun Kim, MD, PhD Department of Ophthalmology, Chosun University School of Medicine, #365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: 82-62-220-3190, Fax: 82-62-225-9839 E-mail: eyekim@chosun.ac.kr

Received 10 January 2019       Revised 28 February 2019       Accepted 17 May 2019

Copyright © 2019 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the effect of steroid treatment on strabismus associated with thyroid ophthalmopathy.

Methods

The present retrospective study was conducted on 22 patients diagnosed with strabismus associated with thyroid ophthalmopathy, who were treated with steroids orally or intravenously and followed up for more than one year. Patients were divided into three groups for analysis: an improved group, with no strabismus at the final follow-up visit; a stable group, with no change in the strabismus angle; and a deteriorated group, in which the strabismus angle had worsened. We investigated the characteristics of each group.

Results

In the gender/sex distribution of the 22 patients, 11 of the 15 patients in the improved or stable group were female; six of seven patients in the deteriorated group were male (p = 0.012). Two of the 15 patients in the improved or stable group had a smoking history. However, none smoked after the treatment had started. On the other hand, five of seven patients in the deteriorated group had a smoking history and continued to smoke during and after treatment (p = 0.001). No significant between-group differences were observed with respect to age, diplopia period, strabismus angle, or thyroid function level.

Conclusions

Treatment with steroids may improve or stabilize strabismus associated with thyroid ophthalmopathy. However, the effect of treatment may differ, depending on whether the patient continues to smoke after treatment is initiated.

Keywords: Steroid treatment, Strabismus, Thyroid ophthalmopathy

References

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Table 1.
Clinical characteristics of patients
Characteristic Value
Study population 22
Sex (male/female) 10/12
Mean age (years) 52.0 ± 10.4
Duration of thyroid dysfunction (months) 14.6 ± 23.3
Duration of diplopia (months) 5.0 ± 11.0
Duration of follow up period (months) 24.0 ± 21.7
Smoker 7 (31.8)
Pretreatment thyroid function  
 Hyperthyroid 11 (50)
 Euthyroid 10 (45.5)
 Hypothyroid 1 (4.5)
 TSH-receptor antibody (U/L) 39.6 ± 23.4
Inflammatory sign present 17 (77.3)
Steroid administration modality (oral/IV) 9/13

Values are presented as mean ± standard deviation or number (%) unless othersiwe indicated.

TSH = thyroid-stimulating hormone; IV = intravenous.

Table 2.
Characteristics of patients who shows improvement in strabismic angle
Case no. Age /sex Diplopia period Pretreatment inflammatory sign/CAS Treatment modality Pretreatment strabismic angle Post 3 months treatment strabismic angle Final strabismic angle Follow up time (months) Smoker/stop smoking
1 40/F 2 weeks Yes/3 Oral 6LHoT Ortho Ortho 30 No
2 47/F 2 months Yes/4 Oral 6RHoT, 4RET Ortho Ortho 12 No
3 48/F 1 month Yes/2 IV 5LET* Ortho Ortho 12 No
4 67/F 5 months Yes/3 IV 12LHoT Ortho Ortho 12 No
5 49/M 1 month No/0 Oral 25LHoT Ortho Ortho 13 No
6 57/M 1 month Yes/4 IV 4LHoT Ortho Ortho 12 Yes/yes
7 51/F 2 weeks Yes/3 Oral 4RHoT Ortho Ortho 48 No
8 56/M 1 week Yes/3 IV 6RHoT Ortho Ortho 12 Yes/yes

CAS = clinical activity score; F = female; HoT = hypotropia; Ortho = orthotropia; ET = esotropia; M = male; IV = intravenous.

* Angle of deviation at secondary position.

Table 3.
Characteristics of patients who shows stability in strabismic angle
Case no. Age/sex Diplopia period (months) Pretreatment inflammatory sign/CAS Treatment modality Pretreatment strabismic angle Post 3 months treatment strabismic angle Final strabismic angle Follow up time (months) Smoker
1 61/M 12 No/0 Oral 30LHT 35LHT 35LHT 65 No
2 55/F 48 Yes/2 IV 25RHT 25RHT 25RHT 72 No
3 56/F 2 No/0 IV 25RHoT 30RHoT 35RHoT 12 No
4 52/F 2 Yes/1 IV 6LHoT 4LHoT 6LHoT 12 No
5 33/F 2 No/0 Oral 6RET 8RET 6RET 24 No
6 56/F 24 No/0 Oral 10LHoT* 8LHoT 10LHoT 72 No
7 56/F 3 Yes/2 Oral 6LHoT* 6LHoT 6LHoT 15 No

CAS = clinical activity score; M = male; HT = hypertropia; F = female; IV = intravenous; HoT = hypotropi; ET = esotropia.

* Angle of deviation at secondary position.

Table 4.
Characteristics of patients who shows deterioration in strabismic angle
Case no. Age/sex Diplopia period (months) Pretreatment inflammatory sign/CAS Treatment modality Pretreatment strabismic angle Post 3 months treatment strabismic angle Final strabismic angle Follow up me (months) Smoker
1 51/M 2 Yes/4 Oral 8RHT, 8RET 8RHT, 8RET 50RHT, 16RET 31 Yes
2 60/M 1 Yes/3 IV 10RHoT 5RHoT 35LET 12 Yes
3 57/M 1 week Yes/4 IV 12RHT 16RHT 20RET 24 Yes
4 75/F 2 weeks Yes/4 IV 18RHoT 16RHoT 55RHoT, 16RET 36 No
5 50/M 1 week Yes/2 IV 6RHT 8RHT 16RHT 12 No
6 35/M 1 Yes/4 IV 6LHoT 8LHoT 20LHoT 12 Yes
7 32/M 2 Yes/3 IV 6RHT 12RHT 20RHT, 12RET 12 Yes

CAS = clinical activity score; M = male; HT = hypertropia; ET = esotropia; IV = intravenous; HoT = hypotropia; F = female.

Table 5.
Probable factors associated with effect of steroid in strabismic patients with thyroid ophthalmopathy
Variable Improved or stable group (n = 15) Deteriorated group (n = 7) p-value
Age 52.26 ± 8.27 51.42 ± 14.77 1.000*
Sex (M/F) 4/11 6/1 0.012†
Diplopia period 6.86 ± 13.00 2.28 ± 1.94 0.783*
Inflammatory sign 11 7 0.131‡
Treatment modality      
 Intravenous 7 6 0.069‡
 Oral 8 1 0.073§
Baseline strabismic angle 10.32 ± 10.68 10.57 ± 4.99 0.319*
Pretreatment thyroid function      
 Hyperthyroid 8 3 0.585§
 Euthyroid 6 4 0.688§
 TSHR ab (IU/L) 43.87 ± 21.53 30.5 ± 26.32 0.217*
Smoker 0 5 0.001§

Values are presented as mean ± standard deviation unless otherwise indicated.

M/F = male/female; TSHR ab = thyroid stimulating hormone receptor antibody.

* Mann Whitney U-test

† smoker means who smokes during steroid treatment

‡ Pearson's chi-square test

§ Fisher's exact test.

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