Wang Yi, Xiao Li-hua, Yang Zhong-kun, Li Yue-yue
Institute of Orbital Diseases, the General Hospital of the Armed Police Force, Beijing, China.
Zhonghua Yan Ke Za Zhi. 2013 Mar;49(3):242-9.
To present a new technique for orbital decompression that minimizes surgical approaches while maximizing the removed areas of orbital walls and to evaluate the efficacy and safety of it for patients with severe thyroid associated ophthalmopathy (TAO).
A retrospective review of 40 cases (66 eyes) with severe TAO undergoing the modified decompression between January 2009 and January 2011 was conducted. All patients were assigned to three groups, which were group CON: compressive optic neuropathy in 30 eyes, group MP: marked proptosis in 30 eyes, and group EK: exposure keratopathy in 6 eyes. The deep lateral, medial walls and orbital floor decompressions were underwent via an eyelid crease or a lateral sub-brow S-shape approach with a transcaruncular approach. Clinical outcomes were recorded including visual acuity, exophthalmometry, diplopia, clinical activity score (CAS) and CT scans before and 6 months after surgery. Intra- and postoperative complications were recorded.
The postoperative visual acuity was improved in 17 eyes (56.7%, P < 0.05) of group CON. The mean proptosis reduction was (8.1 ± 2.7) mm (t = 11.73, P < 0.01) and (11.4 ± 3.1) mm (t = 15.52, P < 0.01) in group CON and group MP, respectively. The CAS was decreased in group CON (P < 0.01). Compared with preoperative records, the degree of diplopia was not significantly different in group CON (U = 131.0, P = 0.309) and group MP (U = 157.5, P = 0.881). Diplopia resolved in 7 cases (39%) of group CON, 5 cases (28%) of group MP. New-onset diplopia or its aggravation was recorded in 3 cases (17%) of group CON, 4 cases (22%) of group MP. The other postoperative improvement included recovered color vision, reduced intraocular pressure, and healing keratopathy. The important complications were intraoperative dural tears, new-onset diplopia and ocular inferior displacement.
The modified orbital decompression offers wide exposure to the three orbital walls, marked proptosis reduction, and no apparent scar. It is efficacious and safety for the treatment of CON and inflammatory activity of TAO without serious complications, meanwhile, has little risk of induced diplopia.
介绍一种眼眶减压新技术，该技术能在尽量减少手术入路的同时最大化眼眶壁切除面积，并评估其对重度甲状腺相关性眼病（TAO）患者的疗效和安全性。
对2009年1月至2011年1月期间接受改良减压手术的40例（66眼）重度TAO患者进行回顾性研究。所有患者分为三组，即CON组：30眼存在压迫性视神经病变；MP组：30眼有明显眼球突出；EK组：6眼有暴露性角膜病变。通过睑缘切口或眉下外侧S形切口联合经泪阜切口进行眶外侧壁、内侧壁及眶底减压。记录临床结果，包括视力、眼球突出度测量、复视、临床活动评分（CAS）以及手术前后的CT扫描结果。记录术中及术后并发症。
CON组17眼（56.7%）术后视力改善（P<0.05）。CON组和MP组的平均眼球突出度分别降低了（8.1±2.7）mm（t=11.73，P<0.01）和（11.4±3.1）mm（t=15.52，P<0.01）。CON组的CAS降低（P<0.01）。与术前记录相比，CON组（U=131.0，P=0.309）和MP组（U=157.5，P=0.881）的复视程度无显著差异。CON组7例（39%）、MP组5例（28%）复视消失。CON组3例（17%）、MP组4例（22%）出现新发复视或复视加重。其他术后改善包括色觉恢复、眼压降低和角膜病变愈合。重要并发症包括术中硬脑膜撕裂、新发复视和眼球下移。
改良眼眶减压术可广泛暴露三个眼眶壁，显著减轻眼球突出，且无明显瘢痕。该方法治疗CON及TAO的炎症活动有效且安全，无严重并发症，同时诱发复视的风险较小。
