甲状腺相关眼病行眼外肌后徙松解术的疗效观察  

The effect of surgical treatment on thyroid-associated ophthalmopathy

作　　者：李辉[1] 闫洪欣[2] 刘玉华[1] 李东辉[1] 张玥[1] 艾凤荣[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院眼科眼科研究中心,100730 [2]解放军第三六医院眼科

出　　处：《中华眼科杂志》2005年第9期772-776,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨甲状腺相关眼病(TAO)致限制性斜视患者眼外肌后徙松解术后,视力、眼压、视野、视网膜中央动脉血流速度的变化。方法选择2002年1月至2004年1月于北京协和医院眼科诊治的17例(20只眼)因TAO致限制性斜视行手术治疗的患者,其中1例行上直肌断腱术、1例行上直肌悬吊术、1例行右下直肌后徙联合左上直肌后徙术,余14例(17只眼)行下直肌后徙术。20只患眼手术前、后均检查视力、眼压、视野,测量视网膜中央动脉血流速度,并进行对照比较。结果术后5只眼视力提高≥2行,15只眼维持术前视力;术前、后眼压和视野平均缺损情况比较,差异有统计学意义(P<0.01);术前、后视网膜中央动脉血流参数比较:术后收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)增加及阻力指数(RI)降低(P<0.05)。结论TAO致限制性斜视患者于静止期行眼外肌后徙松解术治疗,不仅可消除复视,使眼球运动好转,而且能提高裸眼视力、缓解眼压、改善视野和视网膜中央动脉血流速度.Objective To evaluate the effect of muscle surgery on strabismus caused by extraocular muscle for thyroid-associated ophthalmopathy （ TAO）, and assess the change of vision acuity, intraocular pressure, visual field and blood flow velocity in central retinal artery that made by surgery treatment. Methods Recession and release of the extraocular muscles were used in 17 TAO patients （20 eyes） with strabismus caused by the change of extraocular muscles. In those patients one of them was undergone superior rectus tendon resection and other one was undergone superior rectus suspension. Another patient right eye was undergone inferior rectus recession and the left one with superior rectus recession. For rest of 14 patients with 17 eyes inferior rectus recession was performed. The vision acuity, intraocular pressure, visual field, and blood flow velocity in central retinal artery were measured pre- and post-operatively. Results In 17 patients （20 eyes）, 5 eyes vision acuity improved two or more lines and 15 eyes was unchanged postoperatively . Intraocular pressure and mean defect of visual field showed statistically significance （P 〈 0. 01 ）. The peak systolic velocity （PSV） and the end diastolic velocity （ EDV ） were significantly increased, and the resistance index （IR） was significantly reduced （P 〈 0. 05 ） . Conclusion Muscle surgery of strabismus caused by extraocular muscle for TAO in the quiescent period can eliminate strabismus, decrease intraocular pressure, improve visual field and blood flow velocity in central retinal artery. （Chin J Ophthalmol , 2005,41：772-776）

关 键 词：甲状腺相关眼病 眼外肌后徙松解术 视野 视网膜 眼球运动 血流速度 

分 类 号：R779.6[医药卫生—眼科]