甲状腺相关性眼病眼外肌病变的手术治疗  

Operative effect about extraocular myopathy in patients with Thyroid-associated ophthalmopathy

作　　者：黄勇志[1] 何剑峰[1] 

机构地区：[1]广西医科大学第一附属医院眼科,中国人民解放军第三○三医院眼科,广西南宁530021

出　　处：《中国伤残医学》2016年第2期6-9,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：观察甲状腺相关性眼病眼外肌病变手术治疗临床效果. 方法：回顾性分析我院13例14眼TAO眼外肌病变手术病例,男9例,女4例,年龄28～61岁,平均46岁,均为垂直性斜视,术前均存在持续性复视和代偿头位,术前斜视度25 °～45 °,术后随访3～18个月. 疗效标准：成功第一眼位正或斜视度≤5 °,第一眼位或阅读位无复视或残留复视可通过低度三菱镜矫正,代偿头位消失;失败第一眼位斜视度＞5°,第一眼位或阅读位残留持续性复视,难以用三菱镜矫正,代偿头位无明显改善.结果：所有患者均行单条受累直肌松解后退术. 76.9%患者第一眼位正,重建双眼单视,15.4%患者在第一眼位残存少量斜视（≤5°）,所有患者代偿头位均得到矫正,手术成功率为92.3%. 第二眼位均无法完全消除复视,术后眼球活动度明显好转,未发现严重手术并发症. 结论：TAO眼外肌病变在炎症消退、眼位稳定后手术安全有效,单条直肌松解后退能矫正大度数限制性斜视,明显改善复视和代偿头位.Objective：To discuss surgery effect about extraocular myopathy in patients with Thyroid -associated ophthalmopathy . Methods：The surgical management of strabismus in 13 cases with Thyroid -associated ophthalmopathy who received extraocular muscle surgery in our hospital were retrospectively analyzed .Nine cases were males and 4 were females,ranging in age from 28 to 61 years（mean：46 years）.All patients were Vertical strabismus.The preoperative deciation of all cases was 25°to 45°.The patients were followed up for 3 ～18 months.Postoperative results were divided into 2 categories：successful outcome ：orthotropia, or deviation ≤5°,there was no di-plopia or residual little diplopia could being corrected by low degree prism in primary position or reading position ,compensatory head pos-ture disappeared;Failure：deviation 〉5°in primary position,There are persistent diplopia that it was not easy being corrected by prism in primary position or reading position ,Compensatory head posture could not being significantly improved .Results：All patients accepted sin-gle vertical rectus recession .Postoperatively,76.9% patients were orthotropic in primary position , rebuilded binocular field of single vi-sion.There was small residual deviation （≤5°） in primary position in 15.4%patients .All patients could significantly improve compensa-tory head posture. Surgical success rate was 92.8%.Diplopia could not being eliminated in secondary positions .Postoperative eyeball motility improved markedly .Serious complications were not found .Conclusion：The surgical management of extraocular myopathy in pa-tients with TAO was safe and effective after inflammation disappeared and stable eye position , single rectus recession could correct large deviation in patients with restrictive strabismus , It could significantly improve diplopia and compensatory head posture .

关 键 词：甲状腺相关性眼病 眼外肌病变 手术 

分 类 号：R771[医药卫生—眼科]