Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China.
Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.
Am J Ophthalmol. 2015 Feb;159(2):277-84. doi: 10.1016/j.ajo.2014.10.029. Epub 2014 Nov 1.
To describe the surgical technique for endoscopic medial orbital fat decompression in type 1 (lipogenic) Graves orbitopathy and report outcomes.
Retrospective interventional case review.
We reviewed 108 patients (206 orbits) with inactive, type 1 Graves orbitopathy without diplopia, who underwent endoscopic medial orbital fat decompression solely for proptosis reduction. Following endoscopic transethmoid medial orbital wall decompression, extraconal and intraconal orbital fat was removed with a low-suction cutting instrument. All patients were followed up for at least 12 months. Surgical time, preoperative and postoperative Hertel exophthalmometry, incidence of postoperative diplopia within 30-degree visual field in the primary gaze, and other complications were analyzed.
The mean surgical time was 97.7 ± 16.7 minutes (67-136 minutes). The mean follow-up was 16.0 ± 4.2 months (12-24 months). Preoperative and postoperative proptosis values at final review were 21.1 ± 2.3 mm (17-26 mm) and 13.0 ± 0.9 mm (12-15 mm), respectively (P < .001). Median reduction in proptosis was 8.0 mm with mean of 8.2 ± 1.8 mm (4-11 mm). Symmetry to within 2 mm was achieved in 106 of 108 patients (98.1%). Twenty-five of 108 patients (23.1%) had diplopia within 30-degree visual field of the gaze, and 23 of these had complete resolution within 3 months, while the remaining 2 patients required squint surgery.
Endoscopic medial orbital fat decompression may be an effective technique for proptosis in selected patients with type 1 Graves orbitopathy and is associated with a low rate of surgically induced diplopia.
描述 1 型（脂肪生成型）格雷夫斯眼病内镜下内侧眶隔脂肪减压术的手术技术，并报告其结果。
回顾性介入病例研究。
我们回顾了 108 例（206 只眼）无复视的活动期 1 型格雷夫斯眼病患者，这些患者无复视，仅因眼球突出而接受内镜下内侧眶隔脂肪减压术。在经鼻内镜下内侧眶壁减压后，使用低吸力切割器械切除眼外肌和眼内眶脂肪。所有患者均随访至少 12 个月。分析手术时间、术前和术后 Hertel 突眼计测量值、第一眼注视时 30°视野内术后复视的发生率以及其他并发症。
平均手术时间为 97.7±16.7 分钟（67-136 分钟）。平均随访时间为 16.0±4.2 个月（12-24 个月）。末次随访时，术前和术后的眼球突出值分别为 21.1±2.3mm（17-26mm）和 13.0±0.9mm（12-15mm）（P<0.001）。眼球突出平均减少 8.2±1.8mm（4-11mm），中位数为 8.0mm。108 例患者中有 106 例（98.1%）达到 2mm 以内的对称性。108 例患者中有 25 例（23.1%）在第一眼注视时的 30°视野内出现复视，其中 23 例在 3 个月内完全缓解，而其余 2 例需要斜视手术。
内镜下内侧眶隔脂肪减压术可能是治疗 1 型格雷夫斯眼病患者眼球突出的有效方法，其术后发生复视的几率较低。
