Wu Chris Y, Kahana Alon
a Department of Ophthalmology and Visual Sciences , W. K. Kellogg Eye Center, University of Michigan , Ann Arbor , Michigan , USA.
Orbit. 2017 Apr;36(2):95-101. doi: 10.1080/01676830.2017.1279660. Epub 2017 Feb 14.
Geriatric patients (age ≥ 65) are prone to complications after surgery and are at risk for severe thyroid eye disease (TED). In this study, we aim to identify preoperative demographic and TED patterns associated with geriatric patients who underwent decompression surgery, to examine the effect of age on postoperative strabismus rates, and to identify factors that may contribute to postoperative strabismus in the geriatric subgroup. We retrospectively reviewed patients who underwent thyroid-related orbital decompression surgery at the Kellogg Eye Center, University of Michigan, between 1999 and 2014. Primary outcome was postoperative strabismus requiring palliation with prisms and/or strabismus surgery. Descriptive, univariate, and multivariable logistic regression analyses were used to define association of geriatric age with postoperative strabismus and determine predictors of postoperative strabismus. Of 241 patients, 41 (17.0%) were geriatric. They were less likely to undergo bilateral decompression (P = 0.012), less likely to be current smokers at time of decompression (P = 0.002), and more likely to have preoperative primary gaze diplopia (P = 0.001). Postoperative strabismus rates for geriatric patients (≥ 65 years of age), ages 50-65, 30-50, and < 30, were 73.2%, 41.3%, 31.9%, and 15.8%, respectively (P = 0.002). On multivariable analysis, geriatric age remained an independent risk factor for postoperative strabismus when compared to each age group (P ≤ 0.001). Among geriatric patients in subgroup multivariable analysis, balanced as opposed to lateral wall decompression (P = 0.038) and shorter TED duration (P = 0.031) were independently predictive of postoperative strabismus.
老年患者（年龄≥65岁）术后容易出现并发症，且有患严重甲状腺眼病（TED）的风险。在本研究中，我们旨在确定接受减压手术的老年患者术前的人口统计学特征和TED模式，研究年龄对术后斜视发生率的影响，并确定老年亚组中可能导致术后斜视的因素。我们回顾性分析了1999年至2014年期间在密歇根大学凯洛格眼科中心接受甲状腺相关眼眶减压手术的患者。主要结局是术后需要使用棱镜和/或斜视手术进行缓解的斜视。采用描述性、单变量和多变量逻辑回归分析来确定老年年龄与术后斜视的关联，并确定术后斜视的预测因素。在241例患者中，41例（17.0%）为老年患者。他们接受双侧减压的可能性较小（P = 0.012），减压时为现吸烟者的可能性较小（P = 0.002），术前存在原在位复视的可能性较大（P = 0.001）。老年患者（≥65岁）、50 - 65岁、30 - 50岁和<30岁患者的术后斜视发生率分别为73.2%、41.3%、31.9%和15.8%（P = 0.002）。多变量分析显示，与各年龄组相比，老年年龄仍是术后斜视的独立危险因素（P≤0.001）。在老年患者亚组多变量分析中，与侧壁减压相比，采用平衡减压（P = 0.038）和TED病程较短（P = 0.031）是术后斜视的独立预测因素。
