改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的临床效果

目的　评价改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的疗效。方法　回顾性分析2017年1月至2018年8月在云南省第二人民医院行改良结膜入路眼眶内下壁减压术治疗的10例（11眼）轻中度甲状腺相关眼病患者。所有患者在术前均给予眼眶水平位、冠状位和矢状位CT检查，测量视力、眼球突出度、复视情况，检查眼外观进行眼前段照相等。将手术前、后眼球突出度，视力以及复视的改善情况作为效果评价指标，对相关数据进行统计和分析。结果　本组11眼术前眼球突出度为（18.94±1.40）mm，术后（15.22±1.46）mm；术后与术前比较，眼球突出度降低（3.72±0.64）mm，差异有统计学意义（t=18.379，P＜0.001）。术前视力为 0.53±0.29，术后为0.62±0.32；术后与术前比较，视力提高0.08±0.10，差异有统计学意义（t=-2.733，P=0.021）。术前复视2例；术后新发生复视2例，均为轻度复视。术前已存在复视的患者，术后复视程度无加重。结论　改良结膜入路眼眶内下壁减压术能有效改善甲状腺相关眼病患者的眼球突出度与视力，术后复视发生概率低，手术切口隐蔽美观，是一种可靠且有效的眶减压术式。     

甲状腺相关眼病眼眶减压术的疗效分析

目的：探讨眼眶减压术在甲状腺相关眼病中治疗的价值。方法：回顾性分析中山眼科中心1993－2000年27例（30只眼）经全身和眼部临床检查（视力、视野或视觉诱发电位等）确诊为甲状腺相关眼病患者采用眼眶减压术（一壁、二壁及三壁减压）治疗的临床资料,观察其手术前和手术后患者视力、眼球突出度及眼球运动的变化。术后随访2个月至7年,平均13．7个月。结果：视力：19只眼（63．3％）明显提高;4只眼（13．3％）轻度提高,视力均保持在0．2－0．8;4只眼（13．3％）视力无变化,其中3只眼（10．0％）视力下降。24只眼（80．0％）眼球突出后退≥3．0mm,28只眼（93．3％）眼球突出后退≥2．0mm,平均眼球突出后退3．6mm。结论：眼眶减压术可提高甲状腺相关眼病患者的视力,减轻其眼球突出度。     

眶脂肪脱出术治疗甲状腺相关眼病

目的 :回顾和评价眶脂肪脱出术治疗甲状腺相关眼病眼球突出的疗效。方法 :经眼睑或结膜切口入路 ,切除肌肉圆锥内、外的脂肪 ,达到降低眶压 ,减少眼球突出度的目的。结果 :切除眶脂肪 1 5～ 11ml,平均 3 9ml,矫正眼球突出度 2～ 6mm ,平均 3 1mm。该治疗副作用很少 ,不影响视力及眼球运动 ,与提上睑肌延长术联合效果更佳。结论 :眶脂肪脱出术可以缓解眼球突出 ,是治疗甲状腺相关眼病性突眼的有效方法     

经冠状入路眼眶减压术26例

目的探讨经冠状入路眼眶减压术(coronal surgical approach to orbital decompression，CSAD)的临床疗效。方法选择双眼甲状腺相关眼病(thyroid associated Ophthalmopathy，TAO)患者26例(52眼)，行CSAD手术，其中二壁减压20例，三壁减压6例。结果手术前平均睑裂宽度14．5mm，手术后11．7mm；术前平均眼球突出度23mm；术后平均眼球突出16．8mm。平均后退6．2mm，术后视力提高18例(36眼)无变化7例(14眼)减退1例(2眼)；术后复视改善17例，无变化6例，复视症状加重3例。结论CSAD具有减压效果明显，并发症少，术后眼部无瘢痕等优点。     

眼眶脂肪减压术治疗甲状腺眼病的临床研究

目的 评价眼眶脂肪减压术治疗甲状腺相关眼病的疗效.方法 对10例(12只眼)、经眼睑皮肤和(或)结膜切口入路,切除肌肉圆锥内外的眼眶脂肪,1只眼经下睑睫毛下皮肤切口,在切除肌锥内,外脂肪后用高速磨头磨削眼眶下壁骨壁.结果 切除脂肪量1.9～3 ml,平均2.6ml.术后矫正眼球突出度2～3 mm,平均2.4mm.脂肪减压术联合眼眶骨壁磨削的患者出现了术眼眼球向下移位和向下注视时顽固性复视.其余患者未出现并发症.结论 眼眶脂肪减压术可以减轻眼球突出,是一项安全有效的手术方法,但减压效果有限.     

改良三壁眶减压术治疗重症甲状腺相关性眼病的疗效观察

目的观察改良三壁眶减压术治疗重症甲状腺相关性眼病的效果。方法对我院收治的3例(6眼)经内科治疗无效的重症甲状腺相关性眼病患者实施改良三壁眶减压术,观察患者术后视力、眼球突出度及外观情况。结果术后4眼视力轻度提高,2眼保持不变;眼球后退5.3～12.6mm,平均9.5mm;睑裂闭合不全者术后均闭合良好,外观满意;1眼出现少量眶内血肿,治疗后吸收;4眼出现双眼复视,均于1个月内消失;术后CT显示眼眶减压良好。结论改良三壁眶减压术可有效扩大眼眶容积,降低眶内压,还纳眼球,减少眼球突出,改善外观,对内科保守治疗、常规眶减压术无效的重症甲状腺相关性眼病患者安全有效。     

经鼻内镜下眼眶减压术治疗中重度甲状腺相关眼病疗效观察

目的 探讨经鼻内镜下眼眶减压术治疗中重度甲状腺相关眼病的治疗效果。方法 选取我院在2015年6月至2021年5月期间收治的60例中重度甲状腺相关眼病患者为研究对象,所有患者均行经鼻内镜下眼眶减压术,对比患者治疗前和治疗3个月后的最佳矫正视力、眼内压、睑裂高度和眼球突出度。结果 60例87眼中有50只眼(57.5%)术后最佳矫正视力提高,术前术后对比有显著性差异(U=319.7,P=0.04),其余较为稳定,无术后视力持续下降者,术后3月眼球突出度、眼内压和睑裂高度的改善均有显著性差异(t=16.56,P=0.00;t=38.12,P=0.00;t=12.67,P=0.00)。结论 经鼻内镜下眼眶减压术治疗重度甲状腺相关眼病可有效改善患者视力,降低眼内压,利于眼球回退,改善眼部症状。     

眼眶减压术治疗30例恶性突眼的疗效观察

目的 评价眼眶减压术治疗严重恶性突眼患者的疗效。方法 采用眼眶减压术治疗30例(34只眼)恶性突眼患者,其中二壁减压术22,只眼,三壁减压术12只眼。术后随访3个月至9年,平均4．5年。观察恶性突眼患者术后视力、眼球突出度、眼球活动度及外观情况。结果 34只眼术后眼睑均能完全闭合。视力：提高25只眼,无改变5只眼,下降4只眼。眼球突出度：二壁减压术后(18．5mm)较术前(22．3mm)明显减小,三壁减压术后(18．6mm)较术前(25．7mm)明显减小。结论 眼眶减压术是治疗严重恶性突眼的有效方法。     

眼眶二壁减压术治疗12例Graves眼病 压迫性视神经病变

目的评价眼眶减压术治疗压迫性视神经病变的疗效。方法对12例患者14只Graves眼病合并压迫性视神经病变眼施行了二壁眶减压术,减压骨壁尽量靠近眶尖。结果14只眼术后均能完全闭合。视力提高11只眼,基本不变2只眼,下降1只眼。眼球突度平均减少4.0 mm。结论二壁眶减压术是治疗Graves眼病压迫性视神经病变的有效方法。(中华眼底病杂志,2001,17:303-304)     

眼眶减压术20眼临床分析

目的：探讨眼眶减压术对经保守治疗无效的甲状腺相关性眼病的临床疗效与合并症。方法：对12例20眼的术前临床表现、术后的疗效与并发症进行随访并统计。结果：三壁减压使眼球后退6－8mm,外下壁减压后退4－6mm,内下壁减压后退3－5mm。14／16眼（87．5％）角膜损害痊愈,2／16眼（12．5％）好转。17／20眼（85％）视力提高,3／20眼（15％）无改善。并发症包括2眼复视,5眼眶下神经损害,1眼眶继发出血。结论：眼眶减压术对保守治疗无效的甲状腺相关眼病是一种有效、安全、并发症少的治疗手段。可用于继发角膜损害,压迫视神经与要求美容 的病例。     

Balanced orbital decompression combined with fat removal in Graves ophthalmopathy: do we really need to remove the third wall?

PURPOSE: To compare the reduction of proptosis and the incidence of new-onset diplopia after 3-wall (medial, lateral, and inferior) orbital decompression versus balanced medial and lateral wall decompression combined with orbital fat excision in patients with Graves ophthalmopathy. METHODS: Three-wall orbital decompression including medial, inferior, and lateral walls was performed in 13 eyes of 7 patients (group 1), and balanced medial and lateral wall decompression combined with fat removal was performed in 18 eyes of 11 patients (group 2). A transnasal endoscopic approach was used for medial wall removal. A lateral canthotomy incision combined with a short upper eyelid incision was used for extended lateral wall removal, and this was combined with an inferior conjunctival fornix incision when floor decompression was performed. RESULTS: The mean reduction of proptosis was 6.9+/-1.6 mm and 6.5+/-1.3 mm in the first and second groups, respectively; the difference was not statistically significant (P=0.37). After 3-wall decompression, 57.1% of the patients had permanent new-onset diplopia (group 1), whereas none of the patients had permanent postoperative diplopia after balanced medial and lateral wall decompression combined with fat removal (group 2). The difference in permanent new-onset postoperative diplopia between two groups was statistically significant (P<0.001). CONCLUSIONS: Balanced medial and lateral wall decompression combined with orbital fat removal provides an effective reduction in proptosis and reduces the incidence of postoperative permanent diplopia when compared with 3-wall decompression. This technique may eliminate the need for orbital floor excision.     

Surgical Outcomes of Balanced Deep Lateral and Medial Orbital Wall Decompression in Korean Population: Clinical and Computed Tomography-based Analysis

PurposeTo evaluate the clinical outcomes of balanced deep lateral and medial orbital wall decompression and to estimate surgical effects using computed tomography (CT) images in Korean patients with thyroid-associated ophthalmopathy (TAO).MethodsRetrospective chart review was conducted in TAO patients with exophthalmos who underwent balanced deep lateral and medial orbital wall decompression. Exophthalmos was measured preoperatively and postoperatively at 1 and 3 months. Postoperative complications were evaluated in all study periods. In addition, decompressed bone volume was estimated using CT images. Thereafter, decompression volume in each decompressed orbital wall was analyzed to evaluate the surgical effect and predictability.ResultsTwenty-four patients (48 orbits) with an average age of 34.08 ± 7.03 years were evaluated. The mean preoperative and postoperative exophthalmos at 1 and 3 months was 18.91 ± 1.43, 15.10 ± 1.53, and 14.91 ± 1.49 mm, respectively. Bony decompression volume was 0.80 ± 0.29 cm³ at the medial wall and 0.68 ± 0.23 cm³ at the deep lateral wall. Postoperative complications included strabismus (one patient, 2.08%), upper eyelid fold change (four patients, 8.33%), and dysesthesia (four patients, 8.33%). Postsurgical exophthalmos reduction was more highly correlated with the deep lateral wall than the medial wall.ConclusionsIn TAO patients with exophthalmos, balanced deep lateral and medial orbital wall decompression is a good surgical method with a low-risk of complications. In addition, deep lateral wall decompression has higher surgical predictability than medial wall decompression, as seen with CT analysis.     

眼眶减压术治疗甲状腺功能障碍性视神经病变

甲状腺功能障碍性视神经病变(dysthyroid optic neuropathy,DON)是甲状腺相关眼病的严重并发症之一。DON由于多病因导致眶内容物增多、眶内压增高,如延误治疗会造成不可逆性视力丧失。及时行眼眶减压术降低眶内压、减弱疾病活动性是治疗DON抢救视力、改善眼突度等的关键。眼眶减压术包括眼眶眶壁去除减压术、眶内脂肪切除减压术等。近年术式有所改进,包括深外侧壁减压术、内外壁平衡减压术、三壁最大化眶减压术、微创硬膜外眼眶减压术、鼻内镜下不同入路眶壁减压术、计算机辅助减压术、多种术式联合减压等,以期得到更好的治疗效果。(国际眼科纵览,2020,44:431-437)     

Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy

PURPOSE: This study aimed to determine the relative incidence and time course of new-onset strabismus after balanced medial plus lateral wall orbital decompression versus decompression of the lateral wall alone for dysthyroid orbitopathy. METHODS: The study design was a retrospective nonrandomized comparative case series. Thirty-two consecutive patients underwent balanced medial plus lateral wall orbital decompression or lateral wall orbital decompression for dysthyroid orbitopathy. The incidence, duration, and treatment of postoperative strabismus was recorded for each patient. RESULTS: Significant preoperative strabismus was present in 31% (4/13 patients) of the balanced decompression group and in 26% (5/19 patients) of the lateral wall decompression group. Only 25% (1/4) of cases of preexisting strabismus in the balanced decompression group resolved postoperatively without muscle surgery, whereas 60% (3/5) of cases in the lateral wall decompression group resolved postoperatively without surgery. Preoperative strabismus was absent in 69% (9/13) of patients in the balanced decompression group and in 74% (14/19) of patients in the lateral wall decompression group. New-onset, persistent postoperative strabismus developed in 33% (3/9) of patients in the balanced decompression group and in 7% (1/14) of patients in the lateral wall decompression group. CONCLUSION: Lateral wall orbital decompression may produce less new-onset, persistent postoperative strabismus than balanced medial plus lateral wall orbital decompression for dysthyroid orbitopathy.     

甲状腺相关眼病手术治疗前后的眼压变化

目的 评估甲状腺相关眼病(Thyroid-associated ophthalmopathy,TAO)患者行眶减压术或斜视矫正术治疗前后眼压的变化.方法 对象为在2008年12月至2009年12月确诊为TAO,并行眶减压或斜视矫正术患者25例(35只眼),比较患者术前、术后的第一眼位眼压(平视)和第二眼位眼压(上视).结果 行眶减压术16只眼,术前平均眼压为:第一眼位,(17.86±4.32)mmHg,第二眼位(23.55±7.16)mmHg.术后平均眼压为:第一眼位(14.57±3.86)mmHg,下降18.42%,P＜0.05,第二跟位(18.77±4.83)mmHg,下降20.3%,P＜0.04;行斜视矫正术19只眼,术前平均眼压为:第一眼位,(17.89±3.85)mmHg,第二眼位(23.12±6.98)mmHg,术后平均眼压为:第一眼位(15.85±3.60)mmHg,下降11.4,P＜0.05,第二眼位:(17.88±3.59)mmHg,下降19.17%,P＜0.03,其中术前眼压＞21mmHg诊断为高眼压症和诊断为青光眼的患者术后眼压下降的更加明显.结论 TAO患者行眶减压术或斜视矫正术后眼压均有明显下降.     

Change in proptosis following extraocular muscle surgery: effects of muscle recession in thyroid-associated orbitopathy.

PURPOSE: To evaluate the effect of strabismus surgery on proptosis in patients with thyroid-associated orbitopathy. METHODS: The medical records of 22 consecutive patients with thyroid-associated orbitopathy undergoing strabismus surgery were reviewed. Data pertaining to the number of muscles operated on, amount of muscle recession, prior orbital decompression, and exophthalmometry were evaluated. RESULTS: Thirty-eight eyes in 22 patients with thyroid-associated orbitopathy were studied before and after strabismus surgery. The mean change in exophthalmometry following strabismus surgery in all eyes was +0.6 mm (p < 0.01). Eyes with prior decompression averaged a 0.9 mm increase following strabismus surgery (p < 0.01); those without decompression averaged a 0.2 mm decrease (p = 0.658). In eyes that underwent two rectus muscle recessions the increase in Hertel measurements averaged 1.2 mm; when only one muscle was recessed, the average increase was 0.2 mm. In the eyes with muscle recession < or =5 mm, the mean exophthalmometric increase was 0.7 mm. When a muscle recession of more than 5 mm was performed, the exophthalmometry showed a mean increase of 0.5 mm. CONCLUSIONS: Strabismus surgery on patients with thyroid-associated orbitopathy can worsen proptosis, especially in those with prior decompression. When planning for orbital decompression, the surgeon should consider this effect. Moreover, patients should be made aware of the possible changes to their appearance.