Gulati Shashi, Ueland Hans Olav, Haugen Olav H, Danielsen Arild, Rødahl Eyvind
Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
Acta Ophthalmol. 2015 Mar;93(2):178-83. doi: 10.1111/aos.12469. Epub 2014 Jul 2.
To evaluate the outcome of endoscopic decompression in a series of patients with thyroid eye disease.
All 46 patients operated at our institution in the period 2001 to 2011 were invited for re-examination. Thirty-seven patients were included in the study and underwent a general otorhinolaryngological and ophthalmological examination. Nasal endoscopy, autoperimetry and a CT scan of the orbits and paranasal sinuses were performed. Preoperative and early postoperative data were obtained from hospital records. Re-examination was performed from 12 months to 9 years postoperatively. Paired t-test was used to evaluate the change in pre- and postoperative data. Image-guided surgery was used in two patients.
Visual acuity improved from a median value (range) of 0.8 (0.05-1.25) to 1.0 (0.4-1.25) (p=0.006). Intra-ocular pressure (IOP) was reduced from a median value (range) of 18 mmHg (10-27 mmHg) to 14 mmHg (8-24 mmHg) (p<0.001). Median (range) Hertel values were 22.5 mm (14-29 mm) preoperatively and 19 mm (11-26 mm) postoperatively (p<0.001). Mean reduction in proptosis was 4.0 mm. At follow-up, visual fields were normal in 16/37 patients (43%) and with small defects in 12/37 patients (32%). Seventeen patients (46%) had diplopia preoperatively in one or more directions of gaze while 9 (24%) suffered from constant diplopia. After endoscopic decompression, new onset diplopia was seen in seven (19%) individuals, while worsening of diplopia occurred in eight (22%). Impaired motility in abduction and/or elevation was seen in 20 (54%) individuals before decompression and in 23 (62%) after. Strabismus surgery was performed in 22 patients. On final examination 85% of the study population were totally free of diplopia or experienced diplopia only in the peripheral field of gaze. Three patients developed sinusitis. Of these, endoscopic sinus surgery was performed in two patients, and one patient was conservatively treated. Symptoms resolved in all three patients.
Endoscopic medial orbital decompression including removal of the medial floor of the orbit is a safe and effective procedure for treatment of thyroid eye disease. Navigation can be of valuable help to ensure complete resection of the bony walls. However, the majority of patients will need subsequent strabismus surgery, mainly due to significant increase of esotropia.
评估一系列甲状腺眼病患者接受内镜减压术的效果。
邀请了2001年至2011年期间在我们机构接受手术的所有46例患者进行复查。37例患者纳入研究，接受了全面的耳鼻咽喉科和眼科检查。进行了鼻内镜检查、自动视野计检查以及眼眶和鼻窦的CT扫描。术前和术后早期的数据从医院记录中获取。术后12个月至9年进行复查。采用配对t检验评估术前和术后数据的变化。两名患者采用了影像引导手术。
视力从中位数（范围）0.8（0.05 - 1.25）提高到1.0（0.4 - 1.25）（p = 0.006）。眼压从中位数（范围）18 mmHg（10 - 27 mmHg）降至14 mmHg（8 - 24 mmHg）（p < 0.001）。术前Hertel值中位数（范围）为22.5 mm（14 - 29 mm），术后为19 mm（11 - 26 mm）（p < 0.001）。眼球突出平均减少4.0 mm。随访时，37例患者中有16例（43%）视野正常，12例（32%）有小的缺损。17例患者（46%）术前在一个或多个注视方向存在复视，9例（24%）有持续性复视。内镜减压术后，7例（19%）出现新发复视，8例（22%）复视加重。减压术前20例（54%）患者存在外展和/或上抬运动障碍，术后23例（62%）出现该情况。22例患者接受了斜视手术。在最终检查时，85%的研究人群完全没有复视或仅在周边注视视野出现复视。3例患者发生鼻窦炎。其中，2例患者接受了内镜鼻窦手术，1例患者接受了保守治疗。所有3例患者症状均缓解。
包括切除眶内侧壁在内的内镜眶内侧减压术是治疗甲状腺眼病的一种安全有效的方法。导航对于确保骨壁的完全切除可能有重要帮助。然而，大多数患者随后需要进行斜视手术，主要是由于内斜视显著增加。
