Kochetkov P A
I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991.
Vestn Otorinolaringol. 2017;82(1):38-42. doi: 10.17116/otorino201782138-42.
The objective of the present study was to analyze the original results of the transethmoidal decompressive surgical interventions on the eye orbits of the patients presenting with endocrine ophthalmopathy (EOP) including the evaluation of regress of exophthalmos during the post-operative period. The study included 51 patients with endocrine ophthalmopathy at the stage of remission or pharmacotherapeutic compensation of the underlying process. A total of 80 eye-socket were treated in 29 patients with unilateral exophthalmos and 22 ones having bilateral exophthalmos. All the patients underwent transethmoidal decompression of the orbit (TEDO) with the use of the endonasal approach. The examination before and after surgery included the standard ophthalmological evaluation (such as the external inspection, visiometry, tonometry, computed perimetry, biomicroscopy, and ophthalmoscopy) as well as additional studies including exophthalmometry and orbitometry. The activity of endocrine ophthalmopathy was estimated with use of the clinical activity score scale. The main indication for surgery was cosmetically unacceptable exophthalmos. The results of the analysis of the surgical techniques employed in the present study, anatomical features revealed intra-operatively, methods of post-operative care for the patients, and final outcomes of the treatment taken together have demonstrated the high effectiveness of transethmoidal decompressive surgery. Not a single case of visual acuity deterioration was documented during the follow-up period. Persistent convergent strabismus and post-operative diplopia developed in 18% of the patients. Regress of exophthalmos following transethmoidal decompressive orbitotomy varied from 3.5 to 6.5 mm and averaged 5.1 mm in comparison with the mean initial value of 23.9 mm. In means that transethmoidal decompressive orbitotomy ensured the overall regress of exophthalmos by 18.8 mm (p<0.05). The multispiral CT study revealed the significant reduction of the volume of the eye muscles and the intraorbital adipose tissue. It is worthwhile to emphasize the necessity of the detailed preoperative examination of the patients. Our study included the patients presenting with endocrine ophthalmopathy at the stage of remission or pharmacotherapeutic compensation which gave hope of the favourable outcome of the treatment in terms of the degree of regress of exophthalmos and the improvement of the quality of life. The decision to perform transethmoidal decompressive orbitotomy should be taken based on the results of the multidisciplinary conference including an otorhinolaryngologist, ophthalmologist, and endocrinologist. It is concluded that the results of the present study give evidence of the social significance of transethmoidal decompressive orbitotomy taking into consideration that the patients given such treatment experience dramatic improvement of the quality of life.
本研究的目的是分析经筛窦减压手术干预内分泌性眼病（EOP）患者眼眶的原始结果，包括评估术后眼球突出度的消退情况。该研究纳入了51例处于基础疾病缓解期或药物治疗代偿期的内分泌性眼病患者。29例单侧眼球突出患者和22例双侧眼球突出患者共80个眼眶接受了治疗。所有患者均采用鼻内入路进行经筛窦眼眶减压术（TEDO）。手术前后的检查包括标准眼科评估（如外观检查、视力测量、眼压测量、计算机视野检查、生物显微镜检查和检眼镜检查）以及包括眼球突出度测量和眼眶测量在内的其他研究。采用临床活动评分量表评估内分泌性眼病的活动度。手术的主要指征是外观上难以接受的眼球突出。对本研究中采用的手术技术、术中发现的解剖特征、患者的术后护理方法以及治疗的最终结果进行综合分析，结果表明经筛窦减压手术具有很高的有效性。随访期间未记录到一例视力下降的情况。18%的患者出现持续性内斜视和术后复视。经筛窦减压眼眶切开术后眼球突出度的消退范围为3.5至6.5毫米，与初始平均值23.9毫米相比，平均消退5.1毫米。这意味着经筛窦减压眼眶切开术使眼球突出度总体消退了18.8毫米（p<0.05）。多层螺旋CT研究显示眼肌体积和眶内脂肪组织显著减少。值得强调的是，对患者进行详细的术前检查是必要的。我们的研究纳入了处于缓解期或药物治疗代偿期的内分泌性眼病患者，这为在眼球突出度消退程度和生活质量改善方面取得良好治疗效果带来了希望。经筛窦减压眼眶切开术的决策应基于包括耳鼻喉科医生、眼科医生和内分泌科医生在内的多学科会诊结果。得出的结论是，考虑到接受此类治疗的患者生活质量有显著改善，本研究结果证明了经筛窦减压眼眶切开术的社会意义。
