Eckstein Anja, Esser Joachim, Oeverhaus Michael, Saeed Peerooz, Jellema Hinke Marijke
Department of Ophthalmology, University Hospital Essen, Germany.
Department of Ophthalmology, Orbital Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Ophthalmic Plast Reconstr Surg. 2018 Jul/Aug;34(4S Suppl 1):S75-S84. doi: 10.1097/IOP.0000000000001148.
To review the authors' current understanding of motility dysfunction in patients with thyroid eye disease and to summarize appropriate evaluation and available management options.
Data were retrieved from a systematic search of the literature.
Diplopia is one of the most disabling symptoms for Graves orbitopathy patients. It occurs in moderate-to-severe Graves orbitopathy stages and does not respond well to available anti-inflammatory treatment. Inflammation of extraocular muscles induces relatively rapid fibrotic and degenerative changes, which lead to scarring and loss of elasticity with preserved contractility. Inferior and medial rectus muscles are most often involved, which results in horizontal or vertical misalignment or both, and sometimes cyclotorsion. Impaired motility can also be caused by entrapment after orbital decompression. The aim of surgical correction is to restore/enlarge the field of binocular single vision and alleviate abnormal head posture. The basis for successful treatment is dependent on the identification of the involved muscles combined with the correct assessment of motility, misalignment, and binocular single vision.
Due to increased muscle tightness, recessions are the first choice of surgical procedures. Dosing is the most difficult part of the surgery. Several techniques are described: deviation-correction with preoperative determination of the dose, duction-correction either by active or passive intraoperative evaluation of ductions, and the application of adjustable sutures. Achievable success rates are comparable among these techniques but are dependent on the surgeon's experience. Cyclotorsion and misalignment after decompression and combined horizontal and vertical misalignments are more challenging to correct. Those types of deviations need special solutions like surgery on the oblique muscles and the usage of implants. The field of binocular single vision is the main outcome criteria for success, and the quantification may differ for research questions, study designs, and clinical purposes.
回顾作者目前对甲状腺眼病患者运动功能障碍的认识，并总结适当的评估方法和可用的治疗选择。
通过系统检索文献获取数据。
复视是Graves眼眶病患者最致残的症状之一。它发生在中重度Graves眼眶病阶段，对现有的抗炎治疗反应不佳。眼外肌炎症会引发相对快速的纤维化和退行性改变，导致瘢痕形成和弹性丧失，而收缩性保留。下直肌和内直肌最常受累，导致水平或垂直斜视或两者兼有，有时还会出现旋转斜视。眼眶减压后肌肉嵌顿也可导致运动功能受损。手术矫正的目的是恢复/扩大双眼单视视野并减轻异常头位。成功治疗的基础取决于对受累肌肉的识别以及对运动、斜视和双眼单视的正确评估。
由于肌肉紧张度增加，后退术是手术的首选。确定手术量是手术中最困难的部分。描述了几种技术：术前确定手术量进行斜视矫正、术中通过主动或被动评估眼外肌运动进行转位矫正以及应用可调节缝线。这些技术的可实现成功率相当，但取决于外科医生的经验。减压后旋转斜视和斜视以及合并的水平和垂直斜视更具矫正挑战性。这些类型的斜视需要特殊的解决方案，如斜肌手术和植入物的使用。双眼单视视野是成功的主要结局标准，其量化可能因研究问题、研究设计和临床目的而异。
