Abstract
BACKGROUND: Thyroid-associated ophthalmopathy (TAO) represents the most prevalent inflammatory condition affecting the orbital region. Upper eyelid retraction, predominantly affecting young female patients, can result in notable cosmetic issues and psychological distress. This study aimed to evaluate the therapeutic effectiveness and safety of percutaneous para-levator palpebrae superioris (PLPS) injections compared to subconjunctival (SC) injections via the upper fornix (SC) for the treatment of upper eyelid retraction secondary to TAO. METHODS: This retrospective case-control study encompassed patients with TAO who presented exclusively with upper eyelid retraction. Participants were categorized into either the PLPS group or the SC group based on the injection route. The primary outcome measure was the position of the eyelid margin, quantified by the upper margin reflex distance (MRD1). Secondary outcomes included the incidence of complications and recurrence rates. RESULTS: The study enrolled 45 eyes from 45 patients, with 24 eyes in the PLPS group and 21 eyes in the SC group. Both groups exhibited significant improvement in upper lid retraction following treatment. In the PLPS group, the mean reduction in MRD1 was 1.67 mm from baseline, with a complete response rate of 45.8%, a partial response rate of 37.5%, and an overall response rate of 83.3%. In contrast, the SC group demonstrated a mean MRD1 reduction of 1.71 mm, with complete and partial response rates of 66.7 and 14.3%, respectively, resulting in an overall response rate of 81.0%. There was no statistically significant difference in therapeutic efficacy between the two groups (p = 0.205). However, the incidence of elevated intraocular pressure (IOP) was significantly lower in the PLPS group (1/24 eyes, 4.2%) than in the SC group (6/21 eyes, 28.6%) (p = 0.024). No significant differences were observed between the groups concerning menstrual irregularities, post-treatment ptosis, or recurrence rates. CONCLUSION: The administration of triamcinolone acetonide (TA) via PLPS injection demonstrates comparable efficacy to SC injection for the treatment of upper lid retraction in TAO, with a reduced incidence of elevated intraocular pressure.