Clinical Analysis And Curative Effect Observation Of Thyroid Associated Ophthalmopathy In The Elderly Patients

Objective:This study reviewed and analyzed the Clinical characteristics,the factors affecting the severity of the disease and the therapeutic effects of different immunosuppressive therapies in patients aged >60 years with Thyroid-associated ophthalmopathy(TAO),to provide a basis for clinical diagnosis and treatment TAO of the elderly.Methods:This was a retrospective study of the clinical data of 106 patients older than 60 years who were diagnosed as TAO from The First Clinical Hospital of Shanxi Medical University Ophthalmology Department during January 2013 to January 2018.TAO activity was assessed using clinical activity score(CAS),and TAO severity was assessed by NOSPECS grading.Clinical manifestations and imaging findings were analyzed by observation.Spearman method was used to analyze the association between age,gender,smoking,duration of disease and disease severity.Multivariate logistic regression was used to analyze the contributing factors of proptosis and extraocular muscle enlargement.Divided 90 cases with moderate to severe and active TAO into iv methylprednisolone group with 39 cases,combination treatment of triamcinolone acetonide(TA)and cyclosporine A(CSA)group with 35 cases and periocular injection of triamcinolone acetonide group with 16 cases for effect comparison.Results:Older TAO patients were mainly affected by both eyes(95.28%),males were more common(male: female = 1.36:1),age(65.24±4.90)years,and duration of disease(10.32±13.28)months.Older TAO was associated with hyperthyroidism(hyperthyroidism)(74.53%),and the degree of exophthalmos,CAS score and NOSPECS of patients with hyperthyroidism were significantly higher than those with normal thyroid function(P<0.05).The cause of elderly TAO visit is more common in eyelid swelling(79.25%)and double vision(75.47%).The most common eye signs are limited eye movement(81.13%),followed by eyeball protrusion(79.25%).Orbital CT showed that 86.79% of patients had a fusiform hypertrophy in one or more extraocular muscles,and four muscles were more common.The frequency of four eye muscle involvement was in order: lower rectus muscle(28.13%)and medial rectus muscle(26.15%).Upper rectus muscle(24.84%),lateral rectus muscle(20.89%).Smoking was positively correlated with CAS score(P<0.05),and age was positively correlated with NOSPECS grade(P<0.05).Hyperthyroidism,smoking,and duration of disease were risk factors for the degree of exophthalmos(P<0.05).Hyperthyroidism was affecting extraocular muscle involvement.Risk factors(P < 0.05).The total effective rate of group A was 94.87%,the total effective rate of group B was88.57%,and the total effective rate of group C was 75.00%.The total effective rate of group A and group B was significantly higher than that of group C(P<0.05).