Doumit Gaby, Abouhassan William, Yaremchuk Michael J
Cleveland and Cincinnati, Ohio; and Boston, Mass. From the Department of Plastic Surgery, Institute of Dermatology and Plastic Surgery, Cleveland Clinic; the Division of Plastic, Reconstructive & Hand/Burn Surgery, Department of Surgery, University of Cincinnati School of Medicine; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital.
Plast Reconstr Surg. 2014 Sep;134(3):519-526. doi: 10.1097/PRS.0000000000000453.
Graves ophthalmopathy is a chronic, multisystem, autoimmune disorder characterized by increased volume of intraorbital fat and hypertrophic extraocular muscles. Proptosis, impaired ocular motility, diplopia, lid retraction, and impaired visual acuity are treated with orbit decompression and fat reduction. The authors present the addition of skeletal augmentation to further improve periorbital aesthetics.
Through a transconjunctival with lateral canthotomy incision, a balanced orbital decompression was executed, removing medial and lateral walls and medial floor. Intraorbital fat was excised. All patients underwent placement of porous polyethylene infraorbital rim implants and midface soft-tissue elevation, increasing inferior orbital rim projection and improving the globe-cheek relationship. From 2009 to 2012, 13 patients (11 female and two male; 26 eyes) with Graves ophthalmopathy underwent surgery at two institutions. Outcomes were evaluated for improvements of proptosis, diplopia, dry eye symptoms, and cosmetic satisfaction.
Postoperative follow-up ranged from 0.5 to 3 years (median, 1.5 years). The mean improvement on Hertel exophthalmometry was 5.4 mm. Diplopia resolved in three patients (23 percent). No patients had worsening diplopia, and 12 (92 percent) discontinued use of eye lubricants. All patients had cosmetic satisfaction. One patient suffered temporary inferior orbital nerve paresthesia. There were no infections, hematomas, or ocular complications.
Skeletal augmentation is a useful adjunct to orbital decompression and fat excision for treating Graves ophthalmopathy. Balanced orbital decompression with infraorbital rim implants is reliable, effective, and safe, with good, lasting results. Resolution of ocular symptoms is improved, as are the patient's personal well-being and social life, with a high-benefit-to-low-risk.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
格雷夫斯眼病是一种慢性、多系统自身免疫性疾病，其特征为眶内脂肪增多和眼外肌肥厚。眼球突出、眼球运动障碍、复视、眼睑退缩和视力受损可通过眼眶减压和脂肪减少来治疗。作者介绍了增加骨骼增强术以进一步改善眶周美学效果。
通过经结膜联合外眦切开术切口，进行均衡的眼眶减压，去除内侧壁、外侧壁和内侧眶底。切除眶内脂肪。所有患者均植入多孔聚乙烯眶下缘植入物并进行中面部软组织提升，增加眶下缘突出度并改善眼球与脸颊的关系。2009年至2012年，13例格雷夫斯眼病患者（11例女性，2例男性；26只眼）在两家机构接受了手术。评估了眼球突出、复视、干眼症状和美容满意度的改善情况。
术后随访时间为0.5至3年（中位数为1.5年）。Hertel眼球突出计测量的平均改善值为5.4毫米。3例患者（23%）复视消失。没有患者复视加重，12例（92%）患者停止使用眼部润滑剂。所有患者对美容效果均满意。1例患者出现暂时性眶下神经感觉异常。无感染、血肿或眼部并发症。
骨骼增强术是治疗格雷夫斯眼病眼眶减压和脂肪切除的有用辅助手段。采用眶下缘植入物的均衡眼眶减压可靠、有效且安全，效果良好且持久。眼部症状得到改善，患者的个人幸福感和社交生活也得到改善，收益风险比高。
临床问题/证据级别：治疗性，IV级
