深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病

目的：探究深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病的临床治疗效果及安全性。

方法：分析我科既往住院患者病历，纳入2019-01/2020-05在我科住院的符合纳入标准的甲状腺相关性眼病患者17例。所有患者均在全身麻醉下行深外侧壁联合内侧壁眼眶减压术，比较患者术前术后的视力、暴露性角膜炎恢复情况、突眼度、眼压以及并发症情况。

结果：所纳入研究的对象中，有甲状腺相关眼病视神经病变(DON)8例9眼，术前的最佳矫正视力0.78±0.15，术后1mo 0.36±0.12，与术前视力相比有差异(P<0.01)，术后6mo 0.38±0.12，与术后1mo无差异(P=0.594)。术前眼球突出度23.75±2.55mm，术后1mo为14.85±1.53mm，与术前突眼度相比有差异(P<0.01)，术后6mo为14.60±1.64mm，与术后1mo基本保持稳定(P=0.658)。术前眼压25.56±3.23mmHg，术后1mo为18.42±2.35mmHg，与术前相比有差异(P<0.01)，术后6mo眼压降至15.82±2.57mmHg，与术后1mo眼压相比有差异(P<0.01)。术前有暴露性角膜炎6例6眼，术后1mo有4眼好转，2眼治愈，术后6mo 6眼全部治愈。术后患者复视情况均有不同程度减轻，并有部分患者复视症状在此后6mo持续好转，未出现其他严重并发症。

结论：深外侧壁联合内侧壁眼眶减压术可以有效地改善眼突，对DON及暴露性角膜炎等严重并发症也有良好的疗效，并发症少，是治疗严重甲状腺相关性眼病的有效手术方案。

Deep lateral wall combined with medial wall orbital decompression for thyroid associated ophthalmopathy

AIM: To explore the clinical effect and safety of deep lateral wall combined with medial wall orbital decompression in the treatment of thyroid associated ophthalmopathy(TAO).

METHODS: Totally 17 patients with TAO in our department from January 2019 to May 2020 were included. All patients underwent deep lateral wall combined with medial wall orbital decompression under general anesthesia, the visual acuity, recovery of exposure keratitis, exophthalmos, intraocular pressure and complications were compared before and after operation.

RESULTS: Eight patients(9 eyes)with TAO and dysthyroid optic neuropathy(DON)were included in the study. The best corrected visual acuity averaged 0.78±0.15 preoperatively and 0.36±0.12 1mo postoperatively, which was statistically significant(P<0.01)compared with the preoperative visual acuity, 0.38±0.12 at 6mo after surgery, which was not statistically different from that at 1mo after surgery(P=0.594). The mean preoperative proptosis was 23.75±2.55mm and the mean postoperative proptosis was 14.85±1.53mm at 1mo, which was statistically significant compared with the preoperative proptosis(P<0.01), proptosis was on average 14.60±1.64mm at 6mo after surgery and remained generally stable(P=0.658)from 1mo before surgery. The intraocular pressure of the patients was 25.56±3.23mmHg preoperatively and 18.42±2.35mmHg 1mo postoperatively, which was statistically significant compared with the preoperative value(P<0.01), and the intraocular pressure of the patients was reduced to 15.82±2.57mmHg at the 6mo postoperative follow-up, which was statistically significant compared with the intraocular pressure of the patients 1mo postoperatively(P<0.01). There were 6 eyes of 6 patients with exposure keratitis preoperatively, 4 eyes improved and 2 eyes were cured in the 1mo postoperative, and all 6 eyes were cured 6mo postoperatively. Postoperatively, the diplopia of the patients all decreased to various degrees, and there were some patients whose diplopia symptoms continued to improve 6mo thereafter without other serious complications.

CONCLUSION: Deep lateral wall combined with medial wall orbital decompression can effectively improve the proptosis and also have a good effect on severe complications such as DON and exposure keratitis with few complications, so deep lateral wall combined with medial wall orbital decompression is an effective surgical procedure in the treatment of severe TAO.