A controlled clinical study on efficacy and safety of periocular triamcinolone acetonide injection for treating ocular myasthenia gravis

Abstract

Objective: To evaluate the efficacy and safety of peribulbar triamcinolone acetonide injection for treating ocular myasthenia gravis (OMG), with a comparison of traditional oral drug therapy.

Methods: A total of 22 patients with OMG who received periocular triamcinolone acetonide injection (initially 20 mg weekly, then once per month later if symptoms were improved) from July 2019 to July 2022 were evaluated by a comparison of symptom degree before and after treatment. Adverse reactions were also monitored during the period of treatment. The period of follow-up was more than 6 months. Additionally, a comparison of the treatment efficacy between this periocular injection and traditional oral administration was performed in OMG patients.

Results: After 4 weeks of treatment, the degree of ptosis in OMG patients decreased to -3.00 ± 0.69, compared to the value (-0.86 ± 1.32) before treatment. The degree of ophthalmoplegia also decreased from 3.12 ± 0.72 to 0.86 ± 0.88 (P < 0.001) after treatment. The achievement rates of minimal manifestations status (MMS)for ptosis and ophthalmoplegia after 4 week-treatment were 86.3% and 75%, respectively, while they were 50% and 30% in patients with traditional oral administration. There was statistically significant difference only in MMS (rather than symptom relief rate and generalization conversion rate) between two groups. No serious complications (except for intraorbital hematoma) were found in OMG patients during the treatment period.

Conclusion: Repeated peribulbar injection of triamcinolone acetonide can effectively alleviate the initial symptoms of OMG patients. However, the evaluation of its long-term efficacy is still needed.

Clinical trial registry: This study has been clinically registered by Chinese Clinical Trial Registry (ChiCTR), first trial registration date:05/07/2019, registration number: ChiCTR1900024285.

Keywords: Ocular myasthenia gravis; Ophthalmoplegia; Peribulbar injection; Ptosis; Triamcinolone acetonide.

Fig. 1

Typical case 1. a 56-year-old female OMG patient with ptosis in the right eye accompanied by exotropia and diplopia, but there is no obvious limitation of eye movement. After two rounds of peribulbar injection of triamcinolone acetonide, her symptoms of strabismus, and diplopia were alleviated with a slight ptosis. From top to bottom, eye position photos before treatment and 2 weeks after treatment

Fig. 2

Typical case 2. a 22-year-old female patient with OMG who initially had mild ptosis and abduction in the right eye (Figure A). After four injections of triamcinolone acetonide per week, her symptoms were completely relieved (Figure B). The treatment was maintained for 3 months and then discontinued medication. Recurrence occurred 3 months after discontinuation, with ptosis of left eye (Figure C). The patient’s symptoms rapidly worsened, and developed supraduction and neck weakness. Diagnosis of mild GMG was made (Figure D). After re-injection of triamcinolone acetonide with the combination of oral administration of tacrolimus for 6 weeks, her symptoms recovered (Figure E) again. At present, MMS condition was maintained using medication. From top to bottom, Figure A, B, C, D, E