Dataset Information

Botulinum Toxin Type A Injection for Correction of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy.

ABSTRACT: Upper lid retraction (ULR) is the most common and earliest symptom in thyroid-associated ophthalmopathy (TAO) patients. Surgical correction is effective for ULR in stable diseases. However, non-invasive treatment is also required for the TAO patient in active phase. Here, we reported a complex case with TAO and unilateral ULR simultaneously. The patient had a history of progressive ptosis in the left eyelid and underwent anterior levator aponeurotic-Muller muscle resection to correct the ptosis. However, the patient gradually developed bilateral proptosis and ULR, mainly in the left eyelid. The patient was finally diagnosed with TAO with left ULR. Then, the patient was treated with botulinum toxin type A (BTX-A) injection in the left eyelid. The effect of BTX-A treatment started 7 days after injection, peaked at one month, and lasted for approximately 3 months. This study highlighted the therapeutic effect of BTX-A injection for the treatment of ULR-related TAO.

SUBMITTER: Yang J

PROVIDER: S-EPMC10292564 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Botulinum Toxin Type A Injection for Correction of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy.

Yang Jing J Hu Xiuyu X Li Qingfeng Q Huang Ru-Lin RL

The Journal of craniofacial surgery 20230524 5

Upper lid retraction (ULR) is the most common and earliest symptom in thyroid-associated ophthalmopathy (TAO) patients. Surgical correction is effective for ULR in stable diseases. However, non-invasive treatment is also required for the TAO patient in active phase. Here, we reported a complex case with TAO and unilateral ULR simultaneously. The patient had a history of progressive ptosis in the left eyelid and underwent anterior levator aponeurotic-Muller muscle resection to correct the ptosis. ...[more]

PMID: 37221639

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Project description:BackgroundWe aimed to propose a deep learning-based approach to automatically measure eyelid morphology in patients with thyroid-associated ophthalmopathy (TAO).MethodsThis prospective study consecutively included 74 eyes of patients with TAO and 74 eyes of healthy volunteers visiting the ophthalmology department in a tertiary hospital. Patients diagnosed as TAO and healthy volunteers who were age- and gender-matched met the eligibility criteria for recruitment. Facial images were taken under the same light conditions. Comprehensive eyelid morphological parameters, such as palpebral fissure (PF) length, margin reflex distance (MRD), eyelid retraction distance, eyelid length, scleral area, and mid-pupil lid distance (MPLD), were automatically calculated using our deep learning-based analysis system. MRD1 and 2 were manually measured. Bland-Altman plots and intraclass correlation coefficients (ICCs) were performed to assess the agreement between automatic and manual measurements of MRDs. The asymmetry of the eyelid contour was analyzed using the temporal: nasal ratio of the MPLD. All eyelid features were compared between TAO eyes and control eyes using the independent samples t-test.ResultsA strong agreement between automatic and manual measurement was indicated. Biases of MRDs in TAO eyes and control eyes ranged from -0.01 mm [95% limits of agreement (LoA): -0.64 to 0.63 mm] to 0.09 mm (LoA: -0.46 to 0.63 mm). ICCs ranged from 0.932 to 0.980 (P<0.001). Eyelid features were significantly different in TAO eyes and control eyes, including MRD1 (4.82±1.59 vs. 2.99±0.81 mm; P<0.001), MRD2 (5.89±1.16 vs. 5.47±0.73 mm; P=0.009), upper eyelid length (UEL) (27.73±4.49 vs. 25.42±4.35 mm; P=0.002), lower eyelid length (LEL) (31.51±4.59 vs. 26.34±4.72 mm; P<0.001), and total scleral area (SATOTAL) (96.14±34.38 vs. 56.91±14.97 mm2; P<0.001). The MPLDs at all angles showed significant differences in the 2 groups of eyes (P=0.008 at temporal 180°; P<0.001 at other angles). The greatest temporal-nasal asymmetry appeared at 75° apart from the midline in TAO eyes.ConclusionsOur proposed system allowed automatic, comprehensive, and objective measurement of eyelid morphology by only using facial images, which has potential application prospects in TAO. Future work with a large sample of patients that contains different TAO subsets is warranted.

Project description:Repeated injection cycles with abobotulinumtoxinA, a botulinum toxin type A, are recommended in current clinical guidelines as a treatment option for adults with upper limb spastic paresis. However, the magnitude of the maximal therapeutic effect of repeated abobotulinumtoxinA treatment across different efficacy parameters and the number of injection cycles required to reach maximal effect remain to be elucidated. Here, we present a post hoc exploratory analysis of a randomized, double-blind, placebo-controlled trial (12-24 weeks; NCT01313299) and open-label extension study (up to 12 months; NCT0131331), in patients aged 18-80 years with hemiparesis for ≥6 months after stroke/traumatic brain injury. Two inferential methods were used to assess the changes in efficacy parameters after repeat abobotulinumtoxinA treatment cycles: Mixed Model Repeated Measures analysis and Non-Linear Random Coefficients analysis. Using the latter model, the expected maximal effect size (not placebo-controlled) and the number of treatment cycles to reach 90% of this maximal effect were estimated. Treatment responses in terms of passive and perceived parameters (i.e. modified Ashworth scale in primary target muscle group, disability assessment scale for principal target for treatment or limb position, and angle of catch at fast speed) were estimated to reach near-maximal effect in two to three cycles. Near-maximal treatment effect for active parameters (i.e. active range of motion against the resistance of extrinsic finger flexors and active function, assessed by the Modified Frenchay Scale) was estimated to be reached one to two cycles later. In contrast to most parameters, active function showed greater improvements at Week 12 (estimated maximal change from baseline-modified Frenchay Scale overall score: +0.8 (95% confidence interval, 0.6; 1.0) than at Week 4 (+0.6 [95% confidence interval, 0.4; 0.8]). Overall, the analyses suggest that repeated treatment cycles with abobotulinumtoxinA in patients chronically affected with upper limb spastic paresis allow them to relearn how to use the affected arm with now looser antagonists. Future studies should assess active parameters as primary outcome measures over repeated treatment cycles, and assess efficacy at the 12-week time-point of each cycle, as the benefits of abobotulinumtoxinA may be underestimated in the studies of insufficient duration. Abbreviated summary In this post hoc analysis of repeated abobotulinumtoxinA injection cycles in upper limb spastic paresis, Gracies et al. used statistical modelling to elucidate the maximal therapeutic effect of abobotulinumtoxinA. Notably, the number of injections required to reach this maximal effect was higher for active (e.g. active function) compared with passive (e.g. tone) parameters.

Dataset Information

Botulinum Toxin Type A Injection for Correction of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy.

Publications

Botulinum Toxin Type A Injection for Correction of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy.

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