下眶隔切开术与外侧眦切开联合眦松解术在眼眶间隔综合征治疗中的比较。
Inferior orbital septum release compared with lateral canthotomy and cantholysis in the management of orbital compartment syndrome.
机构信息
Vanderbilt University Medical Center, Nashville, USA.
出版信息
Ophthalmic Plast Reconstr Surg. 2012 Jan-Feb;28(1):40-3. doi: 10.1097/IOP.0b013e31823646f3.
PURPOSE
The purpose of this study is to assess the utility of inferior orbital septum release compared with lateral canthotomy and inferior cantholysis for the treatment of orbital compartment syndrome.
METHOD
An experimental study design using a cadaver model for orbital compartment syndrome was used to compare the efficacy of inferior orbital septum release with lateral canthotomy and inferior cantholysis. Elevated orbital compartment pressures were created in a total of 10 orbits of 5 fresh cadaver heads. Compartment pressure and intraocular pressure were measured before and after inferior orbital septum release and lateral canthotomy/cantholysis. Additionally, orbital compartment pressure was compared with intraocular pressure at various pressures to assess correlation. Statistical analysis was performed on the collected data for efficacy comparison of the 2 procedures.
RESULTS
Both procedures were found significantly to reduce orbital compartment pressure. Lateral canthotomy and cantholysis was found to lower the pressure by an average of 56 mm Hg as compared with inferior septal release, which resulted in an average of 52-mm Hg reduction. Performing lateral canthotomy and cantholysis first, followed by inferior septal release, resulted in a total pressure reduction of 73 mm Hg, whereas reversing the order resulted in a reduction of 77 mm Hg. Both the first and second steps, regardless of the order of procedure, were found to result in a significant pressure reduction (p = 0.009 and 0.004, respectively). Comparison of a series of data points collected during the induction of the experimental compartment syndrome revealed a statistically significant correlation between orbital compartment pressure and intraocular pressure (Spearman correlation of 0.978 and p value <0.001).
DISCUSSION
The study demonstrates that both lateral canthotomy/cantholysis and inferior orbital septum release are equally effective at reducing orbital compartment pressure. Additionally, the data support an additive, synergistic reduction in compartment pressure when the procedures are performed consecutively. The correlation of orbital compartment pressure to intraocular pressure proves that intraocular pressure can be used as a reliable measurement of orbital pressure during acute changes in orbital mass. The results of this study demonstrate that the use of inferior orbital septum release in conjunction with lateral canthotomy and cantholysis is superior to the gold standard of isolated lateral canthotomy and cantholysis. We hope that the implementation of orbital septum release will result in superior visual outcomes.
目的
本研究旨在评估下眼眶隔释放术与外侧眦切开和下眦松解术治疗眼眶间隔综合征的效果。
方法
采用眼眶间隔综合征的尸体模型实验设计，比较下眼眶隔释放术与外侧眦切开和下眦松解术的效果。在总共 5 具新鲜尸头的 10 只眼眶中制造眼眶间隔压力升高。在进行下眼眶隔释放术和外侧眦切开/松解术前后测量眼眶间隔压力和眼内压。此外，比较不同压力下眼眶间隔压力与眼内压的关系，以评估相关性。对收集的数据进行统计学分析，比较两种手术的疗效。
结果
两种手术均显著降低眼眶间隔压力。与下眼眶隔释放术相比，外侧眦切开和眦松解术平均降低压力 56mmHg，导致平均压力降低 52mmHg。首先进行外侧眦切开和眦松解术，然后进行下眼眶隔释放术，总压力降低 73mmHg，而相反的顺序则降低 77mmHg。无论手术顺序如何，第一步和第二步均显著降低压力（p=0.009 和 0.004）。比较在实验性间隔综合征诱导过程中收集的一系列数据点，发现眼眶间隔压力与眼内压之间存在统计学显著相关性（Spearman 相关系数为 0.978，p 值<0.001）。
讨论
该研究表明，外侧眦切开/眦松解术和下眼眶隔释放术在降低眼眶间隔压力方面同样有效。此外，数据支持在连续进行这些手术时，眼眶间隔压力呈附加、协同降低。眼眶间隔压力与眼内压的相关性证明，在眼眶质量急性变化期间，眼内压可以作为眼眶压力的可靠测量值。本研究结果表明，与孤立的外侧眦切开和眦松解术相比，联合使用下眼眶隔释放术和外侧眦切开/眦松解术具有优越性。我们希望实施眼眶隔释放术将导致更好的视力结果。
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