갑상샘눈병증 윗눈꺼풀후퇴에서 보툴리눔독소, 트리암시놀론, 5-플루오로우라실 혼합주사의 효과
Effect of Mixed Injection of Botulinum Neurotoxin, Triamcinolone and 5-Fluorouracil in Graves’ Upper Eyelid Retraction
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목적: 윗눈꺼풀 후퇴를 보이는 갑상샘 눈병증 환자에서 보툴리눔독소, 트리암시놀론, 5-플루오로우라실을 혼합한 국소 주사치료를 시행하고 그 효과를 알아보고자 하였다. 대상과 방법: 갑상샘 눈병증으로 진단 받은 환자 중, 윗눈꺼풀 후퇴로 윗눈꺼풀에 보툴리눔신경독소 A 4 IU/0.1 mL, 트리암시놀론 4 mg/0.1 mL, 5-플루오로우라실 5 mg/0.1 mL 혼합주사치료를 받은 환자 17명의 24안을 대상으로 의무기록을 후향적으로 분석하였다. 결과: 환자들의 평균 연령은 43.9 ± 10.4세였고, 갑상샘눈병증의 유병기간은 17.4 ± 28.3개월이었으며 추적관찰기간은 9.0 ± 6.0개월이었다. 주사 치료 1개월 후 margin reflex distance 1 (MRD1)은 5.6 ± 1.2 mm에서 4.7 ± 1.1 mm로 통계적으로 유의한 감소를 보였고, tarsal platform show는 1.4 ± 1.3 mm에서 1.8 ± 1.3 mm, 눈물막파괴시간은 5.2 ± 3.1초에서 10.3 ± 7.8초로 통계적으로 유의한 증가를 보였다. 주사 후 MRD1이 1 mm 이상 교정된 치료 성공률은 66.7%였다. MRD1이 1 mm 이상 교정 유지된 것을 생존으로 보았을 때, 갑상샘눈병증 유병기간에 따른 생존분석에서는 유병기간 6개월 이하인 군에서 평균 유지기간 5.7개월, 6개월 초과인 군에서는 7.5개월로 유병기간이 6개월 초과인 군에서 유지기간과 50% 생존기간이 길었다. 주사 후 복시, 눈꺼풀처짐, 안압 상승 등의 심각한 부작용은 없었다. 결론: 윗눈꺼풀후퇴 환자에서 보툴리눔신경독소 A, 트리암시놀론, 그리고 5-플루오로우라실 혼합주사법은 단독 주사의 단점을 보완하고 장기적 섬유화의 억제를 도모하여, 지속기간이 길고 심각한 부작용이 없는 안전하고 효과적인 방법이다.
Abstract
Purpose: The aim of this study is to evaluate the effects and complications of mixed injections of botulinum neurotoxin A (BoNT-A), triamcinolone acetonide, 5-fluorouracil (5-FU) in patients with Graves upper eyelid retraction. Methods: Twenty-four eyes of 17 patients with a mean age of 43.9 years showed symptoms of Grave’s upper eyelid retraction (GUER). They received mixed injections of BoNT-A 4 IU/0.1 mL, triamcinolone acetonide 4 mg/0.1 mL and 5-FU 5 mg/0.1 mL via subconjunctival injection. The response to treatment and the presence of adverse effects were followed up for 9.0 ± 6.0 months and evaluated retrospectively. Results: Margin reflex distance 1 decreased significantly from 5.6 ± 1.2 mm to 4.7 ± 1.1 mm at 1 month after injection. Tarsal platform show increased significantly from 1.4 ± 1.3 mm to 1.8 ± 1.3 mm, and tear break up time increased significantly from 5.2 ± 3.1 seconds to 10.3 ± 7.8 seconds. When success was defined as the correction amount of GUER being larger than 1 mm, the success rate was 66.7%. Kaplan-Meier survival analysis showed that GUER correction effects last longer in patients with a duration of disease longer than 6 months. There were no severe adverse effects such as diplopia, blepharoptosis and intraocular pressure elevation. Conclusions: Mixed injections of BoNT-A, triamcinolone acetonide and 5-FU, which compensate the side effects of solitary injection and enhances the anti-fibrotic effect, improves the eyelid position and tear film stability in the patients with GUER. It is an effective and safe method for treating GUER with long maintenance with less adverse effects.
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