Kauh Courtney Y, Gupta Shivani, Douglas Raymond S, Elner Victor M, Nelson Christine C, Niziol Leslie M, Kahana Alon
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A.
Ophthalmic Plast Reconstr Surg. 2015 Sep-Oct;31(5):385-90. doi: 10.1097/IOP.0000000000000356.
To characterize the presenting characteristics, preoperative clinical activity score (CAS), surgical approach, and visual outcomes in patients with thyroid eye disease undergoing repeat orbital decompression for recurrent or recalcitrant compressive optic neuropathy (CON).
The medical records of patients with recurrent or recalcitrant CON undergoing repeat orbital decompressions were retrospectively reviewed. The primary outcome measures included pre- and postoperative Humphrey visual field mean deviation, visual acuity (VA) measured in logarithm of the minimal angle of resolution, color vision measured by Ishihara plates, and presence of relative afferent pupillary defect. Details of the surgical procedure and each patient's CAS at presentation were also recorded.
Six patients, 9 orbits, with a mean preoperative CAS of 3.8 were included in this review. The mean time between initial decompression and presentation to our center for recurrent or persistent CON symptoms was 8.6 years (range, 1 to 15 years). At presentation, the average Humphrey visual field mean deviation was -16.5 (standard deviation: 8.8), improving to -3.8 (2.4) postoperatively with a mean of 9.3 months follow up (mean improvement of 75%). Preoperative VA was 0.34 (0.23) LogMAR, improving to 0.05 (0.10) LogMAR with a mean follow up of 10.4 months. Pre- to postoperative comparisons of clinical measures all showed statistically significant improvement (p < 0.05). Eight eyes presented with decreased VA (any VA < 20/20), 4 with decreased color vision (any color vision < 11), and 1 with a relative afferent pupillary defect, and all these patients demonstrated improvement following repeat orbital decompression.
In patients with thyroid eye disease, symptoms of recurrent CON occurred up to 15 years following initial orbital decompression underscoring the smoldering, progressive nature of the disease. Repeat decompression that focused on the orbital apex resulted in visual improvement in all 6 patients. Despite clinical evidence of CON, the mean CAS of these patients at presentation was only 3.8, highlighting the importance of close monitoring of patients with thyroid eye disease following decompression regardless of the external manifestations of disease activity.
描述因复发性或顽固性压迫性视神经病变（CON）接受再次眼眶减压手术的甲状腺眼病患者的临床表现特征、术前临床活动评分（CAS）、手术方式及视力预后情况。
对因复发性或顽固性CON接受再次眼眶减压手术的患者病历进行回顾性分析。主要观察指标包括术前及术后 Humphrey 视野平均缺损、以最小分辨角对数表示的视力（VA）、用石原氏色盲测验表测量的色觉以及相对传入性瞳孔障碍的情况。还记录了手术过程细节及每位患者就诊时的CAS。
本研究纳入6例患者共9只眼眶，术前平均CAS为3.8。初次减压至因复发性或持续性CON症状前来本中心就诊的平均时间为8.6年（范围1至15年）。就诊时，平均 Humphrey 视野平均缺损为-16.5（标准差：8.8），术后平均随访9.3个月时改善至-3.8（2.4）（平均改善75%）。术前VA为0.34（0.23）LogMAR，平均随访10.4个月时改善至0.05（0.10）LogMAR。术前术后各项临床指标比较均显示有统计学意义的改善（p < 0.05）。8只眼存在视力下降（任何视力<20/20），4只眼有色觉下降（任何色觉<11），1只眼有相对传入性瞳孔障碍，所有这些患者在再次眼眶减压术后均有改善。
在甲状腺眼病患者中，初次眼眶减压术后长达15年仍可出现复发性CON症状，突出了该病隐匿、渐进的特点。针对眶尖进行的再次减压使所有6例患者视力均有改善。尽管有CON的临床证据，但这些患者就诊时的平均CAS仅为3.8，凸显了无论疾病活动的外在表现如何，对甲状腺眼病患者减压后密切监测的重要性。
