甲状腺相关眼病性视神经病变42例分析  

A retrospective analysis of 42 cases of thyroid-associated ophthalmopathy with dysthyroid optic neuropathy

作　　者：杨忠昆[1] 胡竹林[1] 张利伟[1] 杨亚斌[1] 方成彦[1] 

机构地区：[1]云南省第二人民医院眼科,云南650021

出　　处：《中国实用眼科杂志》2016年第6期618-621,共4页Chinese Journal of Practical Ophthalmology

基　　金：云南省自然科学基金（2013FZ191）

摘　　要：目的观察甲状腺相关眼病（TAO）性视神经病变（dysthyroid optic neuropathy，DON）的临床治疗效果。方法回顾分析2009年至2013年在云南省第二人民医院眼科收治的42例DON患者60只眼的临床资料，并对比其在激素治疗、开眶减压手术治疗前后的疗效。结果研究治疗前患者最佳矫正视力平均为0．25，治疗后患者最佳矫正视力平均为0．6（P〈0．05）；治疗前视野异常的患者为51只眼（86．67％，51／60），治疗后视野异常的患者为7只眼（11．67％，7／60）（P〈0．05）；其余指标如眼压、眶压、眼球突出度、眼肌、眼底等前后对比均有明显改善；激素治疗中18例治疗1个疗程，占42．9％（18／42）；15例治疗2个疗程，占35．7％（15／42）；9例治疗3个疗程，占21．4％（9／42）。26例36只眼行眼眶2-4壁的开眶减压手术，手术后1个月33只眼视力均有不同程度的提高（P〈0．05）；3只眼无提高。且与激素治疗组相比，行开眶减压手术患者视力提高较明显，差异有统计学意义（P〈0．05）。结论DON可有视力、视野、VEP、眶压、眼压、眼底、眼肌等异常；甲泼尼龙和开眶减压手术是治疗DON的有效方法。Objective To observe the treat effect of thyroid-associated ophthalmopathy （TAO） with dysthyroid optic neuropathy （DON）. Methods The clinical data of 42 cases （60 eyes） of TAO with DON diagnosed in 2009-2013 were retrospectively analyzed. Results Average best correct visual acuity （BCVA） was 0.25 before treatment, and 0.6 post treatment. Visual field was abnormal in 51 eyes （86.67%,51/60） before treatment, and 7 eyes （11.67%,7/60） post treatment. Other index, such as intraocular pressure, orbital tense, exophthalmos, eye muscle, fundus had improvement compared with prior treatment. All patients used methylprednisolone pulse therapy, 18 patients received 1 course of treatment 42.9% （18/42）, 15 patients received 2 courses of treatment 35.7% （15/42）, 9 patients received 3 courses of treatment 21.4% （9/42）; 26 patients （36 eyes） undergone orbital decompression surgery. The BCVA improved in 33 eyes, and unimproved in 3 eyes one month later after surgery. Compared with methylprednisolone pulse therapy, the BCVA improved obviously after orbital decompression surgery. Conclusions There are abnormal of visual acuity, visual field, VEP, orbital tense, exophthalmos, eye muscle, fimdus; Methylprednisolone pulse therapy and orbital decompression surgery are effective treatments of DON.

关 键 词：甲状腺相关性眼病 视神经病变 回顾性分析 

分 类 号：R771.3[医药卫生—眼科]