Pribitkin Edmund A, McJunkin Jonathan, Kung Brian, Carrasco Jacqueline R, Bilyk Jurij R, Savino Peter J
Department of Otolaryngology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Ear Nose Throat J. 2009 May;88(5):E12.
Surgical orbital decompression is indicated for patients with compressive optic neuropathy, exposure keratopathy, an uncontrolled elevation of intraocular pressure, globe subluxation, and disfiguring proptosis secondary to Graves ophthalmopathy. Controversy exists, however, regarding the selection of surgical technique to achieve orbital decompression. We compared the results of our combined transnasal endoscopic and transconjunctival approach with those of our combined transnasal endoscopic and transantral approach to orbital decompression. We conducted a retrospective chart review of patients who had undergone medial- and inferior-wall orbital decompression from January 1994 through January 2004. During that time, 189 combined medial- and inferior-wall orbital decompressions were performed on 124 patients; 51 combined endoscopic and transantral decompressions were performed on 28 patients, and 138 combined endoscopic and transconjunctival decompressions were performed on 96 patients. Patient demographics and the degree of preoperative proptosis were statistically equal in the 2 groups. The incidence of optic neuropathy in the transantral group was significantly higher than the incidence in the entire group (p = 0.03), and the incidence of exposure keratopathy was significantly lower in the transantral group than in the entire group (p = 0.03). Postoperatively, the reduction in proptosis in the 2 groups was statistically equivalent, but the transconjunctival group had a significantly lower incidence of both infraorbital hypesthesia (p< 0.0001) and early rhinosinusitis (p = 0.008). Three cases of globe ptosis and 2 of infraorbital neuralgia occurred. No cases of visual loss, worsened optic neuropathy, diplopia in patients without preexisting diplopia, cerebrospinal fluid leak, significant epistaxis, or periorbital hematoma were noted. We conclude that combined endoscopic and transconjunctival orbital decompression offers equivalent efficacy with less postoperative infraorbital hypesthesia and early rhinosinusitis than does combined endoscopic and transantral orbital decompression.
手术性眼眶减压适用于患有压迫性视神经病变、暴露性角膜病变、眼压控制不佳、眼球半脱位以及格雷夫斯眼病继发的毁容性眼球突出的患者。然而，关于实现眼眶减压的手术技术选择仍存在争议。我们比较了经鼻内镜联合经结膜入路与经鼻内镜联合经鼻窦入路眼眶减压的结果。我们对1994年1月至2004年1月期间接受内侧壁和下壁眼眶减压的患者进行了回顾性病历审查。在此期间，对124例患者进行了189次内侧壁和下壁联合眼眶减压；对28例患者进行了51次内镜联合经鼻窦减压，对96例患者进行了138次内镜联合经结膜减压。两组患者的人口统计学特征和术前眼球突出程度在统计学上相等。经鼻窦组的视神经病变发生率显著高于整个组（p = 0.03），经鼻窦组的暴露性角膜病变发生率显著低于整个组（p = 0.03）。术后，两组眼球突出的减轻在统计学上相当，但经结膜组眶下感觉减退（p < 0.0001）和早期鼻窦炎（p = 0.008）的发生率均显著较低。发生了3例眼球下垂和2例眶下神经痛。未发现视力丧失、视神经病变恶化、无既往复视患者出现复视、脑脊液漏、严重鼻出血或眶周血肿的病例。我们得出结论，与经鼻内镜联合经鼻窦眼眶减压相比，经鼻内镜联合经结膜眼眶减压具有同等疗效，且术后眶下感觉减退和早期鼻窦炎较少。
