Ellis Michael P, Broxterman Emily C, Hromas Alan R, Whittaker Thomas J, Sokol Jason A
a Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology , Kansas University Medical Center , Prairie Village , KS , USA.
Orbit. 2018 Oct;37(5):321-324. doi: 10.1080/01676830.2017.1423341. Epub 2018 Jan 10.
Surgical management of ophthalmic Graves' disease traditionally involves, in order, orbital decompression, followed by strabismus surgery and eyelid surgery. Nunery et al. previously described two distinct sub-types of patients with ophthalmic Graves' disease; Type I patients exhibit no restrictive myopathy (no diplopia) as opposed to Type II patients who do exhibit restrictive myopathy (diplopia) and are far more likely to develop new-onset worsening diplopia following medial wall and floor decompression. Strabismus surgery involving extra-ocular muscle recession has, in turn, been shown to potentially worsen proptosis. Our experience with Type II patients who have already undergone medial wall and floor decompression and strabismus surgery found, when additional decompression is necessary, deep lateral wall decompression (DLWD) appears to have a low rate of post-operative primary-gaze diplopia.
A case series of four Type II ophthalmic Graves' disease patients, all of whom had already undergone decompression and strabismus surgery, and went on to develop worsening proptosis or optic nerve compression necessitating further decompression thereafter. In all cases, patients were treated with DLWD. Institutional Review Board approval was granted by the University of Kansas.
None of the four patients treated with this approach developed recurrent primary-gaze diplopia or required strabismus surgery following DLWD.
While we still prefer to perform medial wall and floor decompression as the initial treatment for ophthalmic Graves' disease, for proptosis following consecutive strabismus surgery, DLWD appears to be effective with a low rate of recurrent primary-gaze diplopia.
传统上，Graves眼病的手术治疗依次包括眼眶减压术，其次是斜视手术和眼睑手术。Nunery等人先前描述了Graves眼病患者的两种不同亚型；I型患者无限制性肌病（无复视），而II型患者表现出限制性肌病（复视），并且在内侧壁和眶底减压术后更有可能出现新发复视加重。反过来，涉及眼外肌后徙的斜视手术已被证明可能会加重眼球突出。我们对已经接受过内侧壁和眶底减压术及斜视手术的II型患者的经验发现，当需要进一步减压时，外侧壁深层减压术（DLWD）术后原在位复视的发生率似乎较低。
一个包含4例II型Graves眼病患者的病例系列，所有患者均已接受减压术和斜视手术，之后出现眼球突出加重或视神经受压，因此需要进一步减压。所有病例均采用DLWD治疗。堪萨斯大学获得了机构审查委员会的批准。
采用这种方法治疗的4例患者在DLWD术后均未出现复发性原在位复视，也无需进行斜视手术。
虽然我们仍然倾向于将内侧壁和眶底减压术作为Graves眼病的初始治疗方法，但对于连续斜视手术后出现的眼球突出，DLWD似乎有效，且原在位复视复发率较低。
