改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的临床效果  

Clinical effects of refined transconjunctival inferomedial wall decompression surgery to treat mild to moderate thyroid-associated ophthalmopathy

作　　者：严劼 胡竹林[1] YAN Jie;HU Zhu-Lin(From the Fourth Affiliated Hospital of Kunming Medical University,Kunming Medical University,Yunnan Eye Institute,Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmology,Provincial Innovation Team for Cataract and Ocular Fundus Disease,Expert Workstation of YAO Ke,Kunming 650021,Yunnan Province,China)

机构地区：[1]昆明医科大学第四附属医院昆明医科大学云南省眼科研究所云南省眼科疾病预防防治重点实验室云南省第二人民医院白内障与眼底疾病防治省创新团队云南省姚克专家工作站

出　　处：《眼科新进展》2019年第11期1067-1070,共4页Recent Advances in Ophthalmology

基　　金：云南省眼科研究所、云南省眼科疾病研究重点实验室项目(编号:2017DG008);院士和领军人才培养项目(编号:2017HC010);院士专家工作站项目(编号:2017IC064);云南省卫生科技计划项目(编号:2016NS182);云南省重要眼表疾病预防和诊治新技术研究项目(编号:2018ZF009)~~

摘　　要：目的评价改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的疗效。方法回顾性分析2017年1月至2018年8月在云南省第二人民医院行改良结膜入路眼眶内下壁减压术治疗的10例(11眼)轻中度甲状腺相关眼病患者。所有患者在术前均给予眼眶水平位、冠状位和矢状位CT检查,测量视力、眼球突出度、复视情况,检查眼外观进行眼前段照相等。将手术前、后眼球突出度,视力以及复视的改善情况作为效果评价指标,对相关数据进行统计和分析。结果本组11眼术前眼球突出度为(18.94±1.40)mm,术后(15.22±1.46)mm;术后与术前比较,眼球突出度降低(3.72±0.64)mm,差异有统计学意义(t=18.379,P<0.001)。术前视力为0.53±0.29,术后为0.62±0.32;术后与术前比较,视力提高0.08±0.10,差异有统计学意义(t=-2.733,P=0.021)。术前复视2例;术后新发生复视2例,均为轻度复视。术前已存在复视的患者,术后复视程度无加重。结论改良结膜入路眼眶内下壁减压术能有效改善甲状腺相关眼病患者的眼球突出度与视力,术后复视发生概率低,手术切口隐蔽美观,是一种可靠且有效的眶减压术式。Objective To evaluate the curative effect of refined transconjunctival inferomedial wall decompression to treat mild-moderate thyroid-associated ophthalmopathy(TAO).Methods Totally 10 patients(11 eyes)with mild-moderate TAO from January 2017 to August 2018 in Yunnan Second People’s Hospital were retrospectively analyzed,who were received refined transconjunctival inferomedial wall decompression.All of patients were received orbital computed tomography in coronal,sagittal and horizontal positions and measurements including visual acuity,exophthalmos,diplopia,ocular appearance and anterior segment photography before operation.The improvements of exophthalmos,visual acuity and diplopia before and after operation were taken as evaluating indicators.The related data was counted and analyzed statistically.Results The exophthalmos of 11 eyes was(18.94±1.40)mm before operation and(15.22±1.46)mm after operation.The reduction of exophthalmos was(3.72±0.64)mm,with statistically significant(t=18.379,P<0.001).The visual acuity was 0.53±0.29 before operation and 0.62±0.32 after operation.The visual acuity increased by 0.08±0.1,with statistically significant(t=-2.733,P=0.021).There were 2 patients with diplopia before operation and another 2 patients suffered from diplopia after operation,all of whom were mild diplopia.Diplopia did not exacerbate after operation in the 2 patients who had diplopia before operation.Conclusion Refined transconjunctival inferomedial wall decompression can effectively improve exophthalmos and visual acuity with low rates of diplopia after operation,and the surgical incision is concealed and beautiful,so it is a reliable way for orbital decompression.

关 键 词：结膜入路内下壁眶减压术 甲状腺相关眼病 眼球突出度 矫正 

分 类 号：R777.5[医药卫生—眼科]