目的：探讨眶周注射曲安奈德联合地塞米松对甲状腺相关眼病(TAO)患者眼表功能及泪液动力学的影响。

方法：采用单中心回顾性病例研究，纳入2020年9月至2023年9月我院就诊的TAO患者26例52眼。所有患者均接受眶周注射曲安奈德(20 mg)联合地塞米松(2.5 mg)。比较注射前，注射后1 wk，1 mo患者的临床活动度(CAS)评分、眼表疾病指数(OSDI)评分、泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)、泪河高度(TMH)、角膜荧光素染色(FL)评分、睑板腺缺失及睑板腺分泌物评分。

结果：纳入患者注射前后CAS评分、OSDI评分、SⅠt、BUT、TMH、FL评分、睑板腺分泌物评分比较均有差异(均P<0.05)。注射后1 wk CAS评分、OSDI评分、SⅠt、BUT、TMH、FL评分、睑板腺分泌物评分与注射前比较均有差异(均P<0.0167)； 注射后1 mo CAS评分、OSDI评分、SⅠt、BUT、TMH、FL评分、睑板腺分泌物评分与注射后1 wk比较均有差异(均P<0.0167)； 注射后1 mo CAS评分、OSDI评分、SⅠt、BUT、TMH、FL评分、睑板腺分泌物评分与注射前比较均无差异(均P>0.05)； 纳入患者注射前后睑板腺缺失评分有差异(P<0.05)，但两两比较显示均无差异(P=0.900、0.306)。治疗期间1例患者出现一过性眼压升高(25 mmHg)，经降眼压药物控制后缓解，无继发性青光眼病例。

结论：眶周注射曲安奈德联合地塞米松可短期内显著改善TAO患者的眼表症状、泪膜稳定性及泪液分泌量，但疗效随药物代谢逐渐减弱，且无法逆转结构性损伤，需联合长期干预策略。

METHODS: In this single-center retrospective study, 26 TAO patients(52 eyes)treated between September 2020 and September 2023 received periocular injections of triamcinolone acetonide(20 mg)and dexamethasone(2.5 mg). Clinical parameters, including clinical activity score(CAS), ocular surface disease index(OSDI), Schirmer I test(SⅠt), tear film breakup time(BUT), tear meniscus height(TMH), corneal fluorescein staining(FL), meibomian gland loss, and lipid secretion score, were assessed at baseline, 1 wk, and 1 mo post-injection.

RESULTS: There were statistically significant differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score before and after injection in the included patients(all P<0.05). At 1 wk after injection, there were differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score compared with those before injection(all P<0.0167). At 1 mo after injection, there were differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score compared with those at 1 wk after injection(all P<0.0167). At 1 mo after injection, there were no differences in CAS, OSDI, SⅠt, BUT, TMH, FL score, and meibomian gland secretion score compared with those before injection(all P>0.05). There was a difference in meibomian gland dropout score before and after injection in the included patients(P<0.05), but pairwise comparisons showed no differences(P=0.900, 0.306). During the treatment period, 1 patient experienced transient elevation of intraocular pressure(25 mmHg), which was alleviated after control with intraocular pressure-lowering medication, and no cases of secondary glaucoma occurred.

CONCLUSION: Periocular injection of triamcinolone acetonide combined with dexamethasone provides short-term improvement in ocular surface symptoms, tear film stability and secretion in TAO patients. However, efficacy diminishes over time and does not reverse structural damage. Long-term maintenance therapy is recommended.