Rødahl E, Seland J, Olofsson J, Aanderud S, Kråkenes J
Oyeavdelingen, Haukeland Sykehus, Bergen.
Tidsskr Nor Laegeforen. 1999 May 10;119(12):1737-42.
Thyroid ophthalmopathy is an inflammatory disorder of the extraocular muscles, orbital fat and orbital connective tissue that is most commonly seen in patients with Graves' hyperthyroidism. Inflammation is accompanied by deposition of extracellular matrix components, in particular glycosaminoglycans. The increase in the volume of the orbital contents may lead to periorbital swelling, extraocular muscle dysfunction, disfiguring proptosis, exposure keratitis, increased intraocular pressure and optic nerve compression. In many cases, surgical treatment is necessary for the rehabilitation of patients. In this report, we present a series of patients to illustrate relevant procedures and the results of surgical treatment in patients with thyroid ophthalmopathy. The records of all patients (66) with thyroid ophthalmopathy hospitalized in the Department of Ophthalmology, Haukeland University Hospital 1 April 1994-31 March 1998 were retrospectively evaluated. Orbital decompressions were performed in 43 patients (in 17 for compressive optic neuropathy), squint surgery in 13 patients, correction of eyelid retraction in 20 patients, and removal of excessive skin and fat from the eyelids in 11 patients. Average reduction of proptosis was 4 mm after lateral wall resection, and 6 mm after combined medial and lateral wall resection. Visual acuity improved in patients with compressive optic neuropathy to 6/6 or better in 18/20 eyes (postoperative data were not available for all patients), while that of the remaining two eyes was 6/9 and 6/24, respectively. Squint surgery was successful (no diplopia in primary or reading position) in eight patients after one procedure, and in four after two procedures. One patient has been scheduled for a third procedure due to a severe esotropia. In patients with thyroid ophthalmopathy, suboptimal treatment of the thyroid disorder may worsen the ophthalmopathy. 16 patients had their medication adjusted, ten were referred for thyroid surgery, and one for treatment with radioiodine. Treatment of patients with thyroid ophthalmopathy is a therapeutic challenge requiring close collaboration between different specialists. In severe cases, several surgical procedures may be needed. The complication rate is low, however, and for most patients the functional as well as the aesthetic situation is greatly improved.
甲状腺眼病是一种眼外肌、眶脂肪和眶结缔组织的炎症性疾病，最常见于格雷夫斯甲状腺功能亢进症患者。炎症伴有细胞外基质成分尤其是糖胺聚糖的沉积。眶内容物体积增加可能导致眶周肿胀、眼外肌功能障碍、毁容性眼球突出、暴露性角膜炎、眼压升高和视神经受压。在许多情况下，手术治疗对患者康复是必要的。在本报告中，我们介绍了一系列患者，以说明甲状腺眼病患者的相关手术步骤及手术治疗结果。对1994年4月1日至1998年3月31日在豪克兰大学医院眼科住院的所有66例甲状腺眼病患者的记录进行了回顾性评估。43例患者接受了眼眶减压术（其中17例因压迫性视神经病变），13例患者接受了斜视手术，20例患者进行了眼睑退缩矫正，11例患者进行了眼睑过多皮肤和脂肪切除术。外侧壁切除术后眼球突出平均减少4毫米，内外侧壁联合切除术后减少6毫米。压迫性视神经病变患者的视力在18/20只眼中提高到6/6或更好（并非所有患者都有术后数据），其余两只眼的视力分别为6/9和6/24。8例患者一次手术后斜视手术成功（原在位或阅读位无复视），4例患者两次手术后成功。1例患者因严重内斜视计划进行第三次手术。在甲状腺眼病患者中，甲状腺疾病治疗不当可能会使眼病恶化。16例患者调整了药物治疗，10例患者被转诊接受甲状腺手术，1例患者接受放射性碘治疗。甲状腺眼病患者的治疗是一项治疗挑战，需要不同专科医生密切合作。在严重病例中，可能需要进行多种外科手术。然而，并发症发生率较低，对大多数患者而言，功能和美观状况都有很大改善。
