Leong Samuel C, White Paul S
Department of Paediatric Otolaryngology-Head and Neck Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, England, UK.
Curr Opin Otolaryngol Head Neck Surg. 2010 Feb;18(1):37-43. doi: 10.1097/MOO.0b013e328335017c.
Graves' disease is a multiorgan autoimmune disease of complex pathophysiology that primarily affects the thyroid gland and orbit. The ophthalmic manifestations of Graves' disease may vary from mild proptosis which causes minimal cosmetic embarrassment to subluxation of the globe, exposure keratitis, corneal abrasion and even blindness. This article focuses on outcomes following orbital decompression.
Surgical techniques have evolved with improved understanding of sinonasal anatomy and being technology-driven with the use of the fiberoptic endoscope and image guidance. The most common surgical outcome reported in the literature is reduction in proptosis, followed by visual acuity and intraocular pressure. Quality-of-life assessments are not routinely measured.
There are a myriad of surgical techniques currently in practice which underscores the fact that no single technique is clearly superior to another. Endoscopic decompression results in a mean reduction of 3.50 mm and is associated with a low complication rate. Nevertheless, the literature suggests that the best techniques are likely to be multiwall approaches such as combined medial and lateral wall decompression. Management of dysthyroid ophthalmopathy is clearly multidisciplinary. Future studies should consider a minimum data set for reporting outcome measures which should include a quality of life tool.
格雷夫斯病是一种多器官自身免疫性疾病，病理生理复杂，主要影响甲状腺和眼眶。格雷夫斯病的眼部表现各异，从轻微突眼（仅引起轻微的美容问题）到眼球半脱位、暴露性角膜炎、角膜擦伤甚至失明。本文重点关注眼眶减压术后的结果。
随着对鼻窦解剖结构认识的提高以及光纤内窥镜和图像引导技术的应用，手术技术不断发展。文献报道的最常见手术结果是突眼减轻，其次是视力和眼压改善。生活质量评估未常规进行测量。
目前有多种手术技术在临床应用，这突出表明没有一种技术明显优于其他技术。内镜减压平均可使突眼减少3.50毫米，且并发症发生率较低。然而，文献表明最佳技术可能是多壁减压方法，如联合内外壁减压。甲状腺相关眼病的治疗显然需要多学科协作。未来研究应考虑采用最小数据集来报告结果指标，其中应包括生活质量工具。
