Wu Chris Y, Elner Victor M, Kahana Alon
Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A.
Ophthalmic Plast Reconstr Surg. 2017 May/Jun;33(3S Suppl 1):S186-S188. doi: 10.1097/IOP.0000000000000585.
Thyroid eye disease (TED) usually has mild manifestations in pediatric patients, and orbital decompression is rarely necessarily. The authors present the clinical course of 3 pediatric patients age 16 or younger at the time of decompression surgery with severe orbitopathy. Case 1 is a 9-year-old prepubertal Asian-American female with Graves' disease and TED who underwent balanced decompression for compressive optic neuropathy. Case 2 is a 14-year-old white female with Graves' disease and TED who underwent balanced decompression for compressive optic neuropathy, stretch optic neuropathy, and globe subluxation. Case 3 is a 14-year-old African-American male with unilateral euthyroid TED who underwent staged right-sided lateral, medial, and floor decompressions for asymmetric proptosis. All cases also had disfiguring proptosis and exposure keratopathy, and in all cases, surgery successfully ameliorated the indications. Children, both pre- and post-pubertal, can rarely manifest visually threatening severe orbitopathy due to TED. This represents the first reports of thyroid-related optic neuropathy and globe subluxation in pediatric patients. Further studies examining the mechanism responsible for the disparities in pediatric and adult TED are warranted.
甲状腺眼病（TED）在儿科患者中通常表现较轻，很少需要进行眼眶减压术。作者介绍了3例在减压手术时年龄为16岁或以下、患有严重眼眶病的儿科患者的临床病程。病例1是一名9岁青春期前的亚裔美国女性，患有格雷夫斯病和TED，因压迫性视神经病变接受了平衡减压术。病例2是一名14岁的白人女性，患有格雷夫斯病和TED，因压迫性视神经病变、牵张性视神经病变和眼球半脱位接受了平衡减压术。病例3是一名14岁的非裔美国男性，患有单侧甲状腺功能正常的TED，因不对称眼球突出接受了分期右侧外侧、内侧和眶底减压术。所有病例均有毁容性眼球突出和暴露性角膜病变，且在所有病例中，手术均成功缓解了相关症状。青春期前和青春期后的儿童很少因TED出现威胁视力的严重眼眶病。这是儿科患者甲状腺相关性视神经病变和眼球半脱位的首例报告。有必要进一步研究导致儿科和成人TED差异的机制。
