Tacea Filofteia, Loane Edward, Grixti Andre, Marsh Ian B, Ziahosseini Kimia
a Ophthalmology Department , Leighton Hospital , Crewe , UK.
b Ophthalmology Department , Aintree University Hospital NHS Foundation Trust , Liverpool , UK.
Strabismus. 2018 Jun;26(2):71-76. doi: 10.1080/09273972.2018.1444067. Epub 2018 Feb 27.
Rectus muscle resection in thyroid eye disease (TED) is generally avoided due to the risk of worsening restriction or reactivating inflammation. However, for some patients with large-angle strabismus or diplopia in primary gaze despite maximum recession surgery, rectus muscle resection may be beneficial. We report our surgical experience with rectus muscle resection in the management of vertical strabismus associated with TED.
Retrospective review of eight patients with TED and vertical diplopia who underwent vertical rectus muscle resection by a single surgeon (IBM) at a tertiary referral centre in Liverpool, UK, from 2001 to 2013. The goal of surgery was elimination of diplopia in primary and reading position. Vertical deviations were measured in prism dioptres () before and after surgery at one month, four months and final visit by prism alternate cover testing at ⅓ m and 6 m.
The mean ± standard deviation vertical deviation for near and distance reduced significantly from 14.2 ± 8.4 and 15.8 ± 8.8 pre-operatively to 5.7 ± 4.9 and 6.7 ± 7 at the four-month visit, respectively (p< 0.05). At the four-month follow-up, five (62.5%) patients achieved binocular single vision in primary and reading position with either no prisms or prisms less than 5. Further recession surgery, Harada-Ito procedure, or lateral rectus resection were necessary in four (50%) patients with persistent diplopia. No patient developed recurrence of inflammation or increased muscle restriction.
Vertical rectus resection could be considered as an additional surgical strategy in the management of TED patients with vertical strabismus without adverse sequelae.
由于存在加重眼球运动受限或重新激活炎症的风险，甲状腺眼病（TED）患者一般避免进行直肌切除术。然而，对于一些尽管进行了最大程度的后退手术但在第一眼位仍存在大角度斜视或复视的患者，直肌切除术可能有益。我们报告了我们在治疗与TED相关的垂直斜视时进行直肌切除术的手术经验。
回顾性分析2001年至2013年在英国利物浦一家三级转诊中心由同一位外科医生（IBM）对8例患有TED和垂直复视的患者进行垂直直肌切除术的情况。手术目标是消除第一眼位和阅读位的复视。术前、术后1个月、4个月及最后一次随访时，通过在1/3米和6米处进行棱镜交替遮盖试验，以棱镜度（ ）测量垂直斜视度。
近距和远距的平均垂直斜视度±标准差术前分别为14.2±8.4和15.8±8.8，在4个月随访时显著降低至5.7±4.9和6.7±7（p<0.05）。在4个月随访时，5例（62.5%）患者在第一眼位和阅读位实现了双眼单视，无需棱镜或所需棱镜度数小于5。4例（50%）持续存在复视的患者需要进一步进行后退手术、原田-伊藤手术或外直肌切除术。没有患者出现炎症复发或肌肉限制增加的情况。
对于患有垂直斜视的TED患者，垂直直肌切除术可被视为一种额外的手术策略，且无不良后遗症。
