甲状腺相关眼病所致限制性斜视的手术效果  

The efficacy of surgery for restrictive strabismus caused by thyroid-associated ophthalmopathy

作　　者：许丽敏[1] 荣军博[1] 郎丽娟[1] 李志刚[1] Xu Limin;Rong Junbo;Lang Lijuan;Li Zhigang(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2021年第5期328-332,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：国家卫生健康委科学研究基金—河南省医学科技攻关计划省部共建项目(SB201901013)。

摘　　要：目的评价手术治疗甲状腺相关眼病(TAO)所致的限制性斜视的效果。方法回顾性分析郑州大学第一附属医院2017年1月至2020年3月的甲状腺相关眼病所致稳定期限制性斜视40例(52只眼)的临床资料。所有患者进行斜视矫正术,术中行牵引试验,将限制作用强的眼外肌行后徙术或断腱术,随访观察术后眼位、眼球运动、复视变化及双眼视功能。结果术前12例为单纯垂直斜视,28例为水平合并垂直斜视。术前水平斜视度平均为(48.97±31.09)PD,术后减少至(7.55±6.93)PD,两者相比差异有统计学意义(t=5.342P<0.001)。术前垂直斜视度为(40.50±23.09)PD,术后减少至(5.60±5.07) PD(t=7.810,P<0.001)。术后35例(87.50%)功能眼位恢复正位,复视症状消失;3例通过佩戴压贴三棱镜症状消除,2例因无法适应压贴三棱镜行二次手术。28例术后恢复近立体视,22例恢复远立体视功能,无眼位过矫者。结论手术治疗TAO限制性斜视,可达到功能性治愈和美容的效果。Objective To evaluate the efficacy of surgical treatment for restrictive strabismus caused by thyroid-associated ophthalmopathy(TAO).Methods This was a retrospective case series study.The clinical data of 52 eyes of 40 cases of TAO with restrictive strabismus from Jan.2017 to Mar.2020 in the First Affiliated Hospital of Zhengzhou University were collected.All cases received traction test during strabismus operation and the recession or tenotomy of rectus muscles was performed on the most restricted muscles.The postoperative eye position,ocular movement,diplopia change and binocular function were followed and observed.Results There were 12 cases with pure vertical squint and 28 cases with horizontal combined vertical squint before operation.The average preoperative horizontal angle was(48.97±31.09)PD,which reduced to(7.55±6.93)PD postoperatively,the difference was statistically significant(t=5.342,P<0.001).The average verticle angle was(40.50±23.09)PD,which reduced to(5.60±5.07)PD postoperatively(t=7.810,P<0.001).After the operation,35 cases(87.50%)of functional eye position reached good alignment,and diplopia disappeared.The symptoms of 3 cases eliminated by wearing press-on prism,2 cases underwent secondary surgery due to inadaption to the press-on prism.Near stereoscopic vision recovered in 28 cases after surgery,and 22 cases restored far stereoscopic vision.None of the case was overcorrected.Conclusion Surgical treatment of restrictive strabismus caused by TAO can achieve functional cure and cosmetical efficacy.

关 键 词：GRAVES眼病 斜视 复视 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]