目的探讨改良眼眶减压术对甲状腺相关眼病(TAO)患者术后眼位保护的作用。
方法采用队列研究方法，将2008年7月至2018年7月在河南省立眼科医院接受眼眶减压术的TAO患者96例136眼按照手术方式不同分成2个组，其中改良眼眶减压术组患者70例100眼，传统眼眶减压术组患者26例36眼。改良眼眶减压术组术中在眼眶尖部作减压骨窗，传统眼眶减压术组术中采用传统的方法在眼眶中前部作减压骨窗。比较2个组手术1个月后最佳矫正视力、睑裂大小、眼球突出度、斜视、眼球位置、CT影像等情况。
结果改良眼眶减压术组100眼中术后斜视改善者10例14眼，无变化者52例75眼，轻度加重者8例11眼，无明显加重者；传统眼眶减压术组36眼中术后无斜视改善者，轻度加重者4例6眼，明显加重者22例30眼。改良眼眶减压术组100眼中术后眼球移位均无明显改善，无变化者64例91眼，轻度加重者6例9眼，无明显加重者；传统眼眶减压术组36眼中术后眼球移位均未改善，轻度加重者10例15眼，明显加重者16例21眼。2个组间不同斜视和眼球移位变化的眼数分布比较差异均有统计学意义( Z＝-9.634、-10.278，均 P<0.01)。改良眼眶减压术组和传统眼眶减压术组术眼术后眼球突出度值分别为(14.36±2.03)mm和(14.17±1.03)mm，明显低于术前的(20.47±1.92)mm和(20.28±2.03)mm，差异均有统计学意义(均 P<0.05)。术后CT影像显示，改良眼眶减压术组术眼眶尖部减压骨窗清晰，传统眼眶减压术组术眼减压骨窗位于眼眶中前部。随访期内改良眼眶减压术组未发现明显不良反应。
结论改良眼眶减压术减少了传统眼眶减压手术加重患者眼位偏斜程度的并发症，对TAO术后的眼位具有保护作用。
ObjectiveTo investigate the protective effect of a modified orbital decompression on postoperative eye position in thyroid-associated ophthalmopathy (TAO).
MethodsA cohort study was performed.One hundred and thirty-six eyes of 96 TAO patients who received orbital decompression in Henan Eye Hospital from July 2008 to July 2018 were enrolled.The patients were divided into two groups according to different operation methods.A depressed bone window was made in the region of orbital apex in the modified orbital decompression group with 100 eyes of 70 patients.A depressed bone window was made in the middle and anterior region of orbit in the traditional orbital decompression group with 36 eyes of 26 patients.The best corrected visual acuity, palpebral fissure, eyeball exophthalmos, strabismus, eyeball position、CT image and postoperative complications were compared.This study was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2020[07]), and written informed consent was obtained from each subject before surgery.
ResultsStrabismus was improved in 14 eyes of 10 patients, unchanged in 75 eyes of 52 patients and slightly aggravated in 11 eyes of 8 patients after operation in the modified orbital decompression group.In the traditional orbital decompression group, strabismus was slightly aggravated in 6 eyes of 4 patients, seriously aggravated in 30 eyes of 22 patients after surgery. In the modified orbital decompression group, the eyeball displacement was unchanged in 91 eyes of 64 patients, slightly aggravated in 9 eyes of 6 patients after surgery in the traditional orbital decompression group, the eyeball displacement was slightly aggravated in 15 eyes of 10 patients, seriously aggravated in 21 eyes of 16 patients after surgery.Significant differences were found in the number of eyes with different degree of strabismus and eyeball displacement between the two groups ( Z=-9.634, -10.278, both at P<0.01). The postoperative eyeball exophthalmos values were (14.36±2.03)mm and (14.36±1.03)mm in the modified orbital decompression group and the traditional orbital decompression group, respectively, which were significantly lower than preoperative (20.47±1.92)mm and (20.28±2.03)mm (both at P<0.05). CT imaging showed that the bone window was clear in orbital apex and the compression of optic nerve was relieved postoperatively in the modified orbital decompression group, and the bone window was in anterior part of the orbit and the orbital apex was still crowded in the traditional orbital decompression group.No severe complication was seen during the fellow-up duration in the two groups.
ConclusionsCompared with traditional orbital decompression, the modified orbital decompression surgery can reduce the risks of strabismus and eyeball displacement, showing an obvious protective effect on eye position.
郑嵩山,柴昌. 改良眼眶减压术对甲状腺相关眼病术后眼位的保护作用[J]. 中华实验眼科杂志,2020,38(11)：951-956.
DOI:10.3760/cma.j.cn115989-20200227-00114版权归中华医学会所有。
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