Baldeschi Lelio, Lupetti Antonella, Vu Phung, Wakelkamp Iris M M J, Prummel Mark F, Wiersinga Wilmar M
Orbital Center, Department of Ophthalmology, University of Amsterdam, Amsterdam, The Netherlands.
Ophthalmology. 2007 Jul;114(7):1395-402. doi: 10.1016/j.ophtha.2006.10.036. Epub 2007 Feb 22.
To present and discuss three cases of apparent reactivation of Graves' orbitopathy (GO) after orbital decompression and to evaluate the incidence of this phenomenon.
Observational case series and retrospective follow-up study.
A few weeks after surgery 2 patients with GO (patients 1 and 2), treated at our institution with rehabilitative bony orbital decompression during the static phase of the disease showed clinical and radiologic evidence of reactivated orbitopathy. After this observation, a sample of 249 patients who had consecutively undergone the same treatment for the same reason before the second of the 2 observed patients was selected for this study.
The records of the selected patients were retrospectively reviewed searching for cases presenting with clinical and radiologic evidence of GO reactivated as a consequence of any type of bony orbital decompression. Patients treated with perioperative systemic glucocorticoids or who had concurrent periorbital diseases, injuries, or surgeries, or who had immunocompromised conditions or a follow-up of < or =2 months, were excluded.
Incidence of reactivation. Clinical history, clinical and radiologic characteristics, treatment modalities, and time course of the reactivation in patients presenting with this phenomenon.
Decompression surgery took place between 1994 and 2000. Eleven patients were excluded for having been treated with perioperative glucocorticoids. Only 1 patient (patient 3) presented with reactivation. The incidence of the phenomenon that we regard as reactivation of GO after rehabilitative bony orbital decompression was therefore 1.3% (3/239). In all 3 patients, the reactivation took place a few weeks after surgery, after an early normal convalescence period and could be controlled with systemic immunosuppression or orbital radiotherapy. None of the patients we report developed further episodes of reactivation during the follow-up period (mean, 7.5 years).
Based on its clinical characteristics, we suggest naming our observation delayed decompression-related reactivation and we propose using its acronym DDRR when referring to it. Although DDRR appears to be a rare event, it is important for physicians and patients to be aware of its possible occurrence with rehabilitative decompression surgery.
呈现并讨论3例眼眶减压术后Graves眼病（GO）明显复发的病例，并评估该现象的发生率。
观察性病例系列及回顾性随访研究。
在疾病静止期接受我院康复性眼眶骨减压治疗的2例GO患者（患者1和患者2），术后几周出现临床及影像学证据显示眼眶病复发。基于这一观察结果，在第2例观察患者之前，选取249例因相同原因连续接受相同治疗的患者作为本研究样本。
回顾所选患者的记录，查找因任何类型的眼眶骨减压导致GO复发且有临床及影像学证据的病例。排除围手术期接受全身糖皮质激素治疗、伴有眶周疾病、损伤或手术、免疫功能低下或随访时间≤2个月的患者。
复发率。出现该现象患者的临床病史、临床及影像学特征、治疗方式及复发的病程。
减压手术于1994年至2000年间进行。11例因围手术期接受糖皮质激素治疗被排除。仅1例患者（患者3）出现复发。因此，我们认为康复性眼眶骨减压术后GO复发这一现象的发生率为1.3%（3/239）。所有3例患者均在术后几周出现复发，此前有一段早期恢复正常的时期，复发可通过全身免疫抑制或眼眶放疗得到控制。在随访期（平均7.5年）内，我们报告的患者均未再次出现复发。
基于其临床特征，我们建议将我们的观察结果命名为延迟减压相关复发，并建议在提及它时使用其首字母缩写DDRR。尽管DDRR似乎是一种罕见事件，但医生和患者了解其在康复性减压手术中可能发生很重要。
