Kingdom Todd T, Davies Brett W, Durairaj Vikram D
Department of Otolaryngology-Head & Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Oculoplastic & Reconstructive Surgery, San Antonio Military Medical Center, San Antonio, Texas, U.S.A.
Laryngoscope. 2015 Sep;125(9):2034-40. doi: 10.1002/lary.25320. Epub 2015 Apr 17.
OBJECTIVES/HYPOTHESIS: To analyze the clinical outcomes for a large cohort of patients who underwent orbital decompression for thyroid eye disease (TED) utilizing a consistent surgical approach performed by a single surgical team.
Retrospective case series.
Clinical data were gathered for patients who had undergone surgical decompression for TED. Outcomes analysis included reduction in proptosis (millimeters, Hertel measurements), visual acuity change (Snellen chart), diplopia (new or worsening), and complications.
All patients underwent a combined endoscopic transnasal (medial) and transconjunctival (inferior/lateral) approach. A total of 114 surgeries (orbits) were performed on 77 patients during the period 2002 to 2013. Average follow-up was 31.3 months (range, 1-126 months). At last follow up, mean reduction in proptosis across all patients was 3.2 mm (range, 0-9 mm). Postoperatively, no patients reported new diplopia, whereas two patients reported worsening of their existing diplopia (3.8%). Decompression was performed for proptosis in 62 patients (91 orbits), and for compressive optic neuropathy (CON) in 15 patients (23 orbits). When performed for proptosis, mean reduction in proptosis was 3.4 mm. Vision was maintained or improved in all patients, including those presenting with CON.
Analysis of outcomes in this large cohort showed no new cases of diplopia and only two cases of worsening diplopia balanced with a mean reduction in proptosis consistent with previously reported series. In addition, we demonstrate excellent results stratified by clinical indication (proptosis vs. CON). These results validate the combined endoscopic-transconjunctival approach to orbital decompression for patients with symptomatic TED.
目的/假设：分析一大群因甲状腺眼病（TED）接受眼眶减压手术的患者的临床结果，手术由单一手术团队采用一致的手术方法进行。
回顾性病例系列研究。
收集因TED接受手术减压患者的临床数据。结果分析包括眼球突出度降低（毫米，Hertel测量法）、视力变化（Snellen视力表）、复视（新发或加重）及并发症。
所有患者均采用内镜经鼻（内侧）联合经结膜（下/外侧）入路。2002年至2013年期间，对77例患者共进行了114次手术（眼眶）。平均随访时间为31.3个月（范围1 - 126个月）。在最后一次随访时，所有患者眼球突出度平均降低3.2毫米（范围0 - 9毫米）。术后，无患者报告新发复视，而两名患者报告现有复视加重（3.8%）。62例患者（91个眼眶）因眼球突出进行减压，15例患者（23个眼眶）因压迫性视神经病变（CON）进行减压。因眼球突出进行减压时，眼球突出度平均降低3.4毫米。所有患者，包括患有CON的患者，视力均得以维持或改善。
对这一大群患者的结果分析显示，无新发复视病例，仅有两例复视加重，同时眼球突出度平均降低，与先前报道的系列研究结果一致。此外，我们按临床指征（眼球突出与CON）分层展示了出色的结果。这些结果证实了内镜 - 经结膜联合入路对有症状TED患者进行眼眶减压的有效性。
4级
