甲状腺相关性眼病视神经病变患者临床特征及治疗效果  

Clinical profile and visual outcomes after treatment in patients with dysthyroid optic neuropathy

作　　者：徐冬冬[1] 李星辰[1] 徐海燕[1] 李辉[1] 刘玉华[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,北京100730

出　　处：《基础医学与临床》2017年第3期330-334,共5页Basic and Clinical Medicine

基　　金：国家自然科学基金(81271043)

摘　　要：目的观察甲状腺相关性眼病视神经病变(DON)临床特征及治疗效果。方法回顾北京协和医院DON患者临床资料,分析应用糖皮质激素、眼眶放射治疗和眼眶减压术后的治疗效果。结果共有38例患者(67眼)。治疗包括几种方式根据病情变化先后次序的联合,多种方案联合治疗患者32例(84.2%)。治疗前Log MAR视力为0.60±0.59,治疗后为0.18±0.09(P<0.01)。治疗有效组59眼(88.1%),无效组8眼(11.9%)。初始采用激素静脉冲击治疗38眼,其中35眼(92.1%)治疗有效。初始采用其他治疗手段29眼,其中24眼(82.8%)治疗有效(P<0.01)。眼球运动固定有效组3眼(5.1%),无效组4眼(50%)(P<0.05)。眼上肌群厚度有效组(7.63±1.19)mm,无效组(8.81±0.83)mm(P<0.05)。视野平均缺损MD值有效组为2.41±2.82,无效组为11.98±7.07(P<0.05)。结论根据病情变化,多种方案联合治疗DON可有效改善患者视功能。初始治疗建议采用激素静脉冲击。Objective To review the clinical data and visual outcomes after treatment of patients with dysthyroid optic neuropathy（ DON）. Methods We retrospectively examined the clinic data of the 38 patients（ 67 eyes） suffering from DON and analysed the effect of glucocorticoids,radiation and orbital decompression. Results The study included 14 men and 24 women. 32 patients（ 84. 2%） received multiple treatment modalities. Log MAR vision acuity changed from（ 0. 60 ± 0. 59） before treatment to（ 0. 18 ± 0. 09） after treatment（ P 0. 01）. There were 59eyes（ 88. 1%） in the treatment effective group,8 eyes（ 11. 9%） in the ineffective group. 38 eyes underwent initial treatment with intravenous steroid pulse therapy and 35 eyes（ 92. 1%） were effective. 29 eyes were treated with other modalities and 24 eyes（ 82. 8%） were effective（ P 0. 01）. There were 3 eyes（ 5. 1%） suffering from fixed eyeball movement in the effective group,while 4 eyes（ 50%） in the ineffective group（ P 0. 05）. The thickness of the supraocular muscle group in the effective group was（ 7. 63 ± 1. 19） mm,（ 8. 81 ± 0. 83） mm in theineffective group（ P 0. 05）. Mean defect of the visual field was（ 2. 41 ± 2. 82） in the effective group and（ 11. 98 ±7. 07） in the ineffective group（ P 0. 05）. Conclusions Treatment with multiple modalities effectively improved visual outcomes in cases of DON. Intravenous pulse steroid therapy was recommended as the initial modality.

关 键 词：甲状腺相关性眼病 视神经病变 激素 减压术 放疗 

分 类 号：R771.3[医药卫生—眼科]