Metson Ralph, Samaha Mark
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Laryngoscope. 2002 Oct;112(10):1753-7. doi: 10.1097/00005537-200210000-00008.
Although endoscopic orbital decompression has become the surgical treatment of choice for patients with proptosis from Graves disease, postoperative diplopia requiring corrective eye muscle surgery can occur in up to 63% of patients. The purpose of the study was to evaluate a new technique intended to reduce the incidence of diplopia following endoscopic orbital decompression.
Case-control.
Endoscopic orbital decompression was performed on 58 orbits in 37 patients with proptosis from Graves disease. The orbital sling technique, which makes use of a horizontal strip of periorbital fascia to prevent prolapse of the medial rectus muscle, was used on 20 orbits in 13 patients. Conventional endoscopic decompression was performed in 24 control subjects. The mean duration of follow-up was 3.3 +/- 1.3 years (range, 1.7-5.1 y).
The incidence of new-onset or worsened diplopia following endoscopic decompression was significantly lower for the orbital sling group compared with control subjects (0% vs. 29.2%, respectively [ =.038]). No patients in the orbital sling group developed new-onset diplopia following surgery. Of the eight patients with pre-existing diplopia from the orbitopathy, double vision improved in four patients (50%) and was unchanged in the remaining four patients (50%). The mean reduction in proptosis was comparable for the orbital sling and control groups (5.1 +/- 1.1 mm vs. 5.0 +/- 1.9 mm, respectively [ P=.98]). CONCLUSIONS The preservation of a fascial sling overlying the medial rectus muscle during endoscopic orbital decompression appears to reduce the incidence of postoperative diplopia, while still allowing for a satisfactory reduction in proptosis. This modification of the standard decompression technique should be considered for the treatment of patients with proptosis.
尽管内镜下眼眶减压术已成为Graves病所致眼球突出患者的首选外科治疗方法，但高达63%的患者术后可能出现需要进行眼肌矫正手术的复视。本研究的目的是评估一种旨在降低内镜下眼眶减压术后复视发生率的新技术。
病例对照研究。
对37例Graves病所致眼球突出患者的58个眼眶进行了内镜下眼眶减压术。13例患者的20个眼眶采用了眼眶吊带技术，该技术利用眶周筋膜的水平条带防止内直肌脱垂。24例对照者接受了传统的内镜减压术。平均随访时间为3.3±1.3年（范围1.7 - 5.1年）。
与对照组相比，眼眶吊带组内镜减压术后新发或加重复视的发生率显著降低（分别为0%和29.2%[P = 0.038]）。眼眶吊带组术后无患者出现新发复视。在8例因眼眶病已有复视的患者中，4例（50%）复视改善，其余4例（50%）无变化。眼眶吊带组和对照组眼球突出的平均减少量相当（分别为5.1±1.1 mm和5.0±1.9 mm[P = 0.98]）。结论在内镜下眼眶减压术中保留覆盖内直肌的筋膜吊带似乎可降低术后复视的发生率，同时仍能使眼球突出得到满意的减轻。对于眼球突出患者的治疗，应考虑对标准减压技术进行这种改良。
