Scofield-Kaplan Stacy M, Dunbar Kristen, Stein Gregory, Kazim Michael
Department of Ophthalmology, Columbia-Presbyterian Medical Center, Edward S. Harkness Eye Institute, New York, New York, U.S.A.
Ophthalmic Plast Reconstr Surg. 2018 Jul/Aug;34(4S Suppl 1):S85-S89. doi: 10.1097/IOP.0000000000001143.
To evaluate the improvement in primary and eccentric gaze ocular alignment in thyroid eye disease (TED) patients undergoing horizontal strabismus surgery with Tenon's recession.
This is an Institutional Review Board-approved retrospective analysis of TED patients undergoing horizontal strabismus surgery for esotropia. The study included all patients from 2007 to 2016 operated on by a single surgeon at Columbia University Medical Center. Surgical success was defined as the ability to fuse at both near and distance either without prismatic correction or with less than 10 prism diopters (PD) of correction. Measurements of ocular alignment were also made in eccentric fields of gaze. This study was Health Insurance Portability and Accountability Act compliant with protection of individually identifiable information.
Thirty-eight patients with TED and restrictive horizontal strabismus underwent unilateral or bilateral medial rectus recession to relieve diplopia. All patients underwent Tenon's recession with dissection of Tenon's from the overlying conjunctiva permitting it to retract into the orbit. Overall the success rate was 87% with a reoperation rate of 7.9%. The improvement in horizontal deviation in both primary and eccentric gaze was statistically significant (p < 0.001). The change in vertical deviation in the 5 cardinal positions of gaze was not statistically significant. The postoperative change in vertical deviation was not proportional to the preoperative horizontal deviation or the amount of horizontal recession.
Due to the preoperative incomitance of ocular deviations in TED patients, persistent postoperative eccentric misalignment is expected. The addition of Tenon's recession to TED-horizontal strabismus surgery led to statistically significant improvement in ocular alignment in both primary and eccentric gaze. This is the first study of TED-strabismus surgery to analyze the postoperative results in positions outside of primary and reading gaze. The authors postulate that the release of scar tissue by the addition of Tenon's recession contributes to these improvements.
评估接受水平斜视手术联合眼球筋膜后退术的甲状腺眼病（TED）患者在第一眼位和偏心注视时眼位的改善情况。
这是一项经机构审查委员会批准的对因内斜视接受水平斜视手术的TED患者的回顾性分析。该研究纳入了2007年至2016年在哥伦比亚大学医学中心由同一位外科医生进行手术的所有患者。手术成功定义为在近距和远距均能融合，无需棱镜矫正或矫正棱镜度小于10棱镜度（PD）。还在偏心注视视野中进行了眼位测量。本研究符合《健康保险流通与责任法案》，保护了可识别个人身份的信息。
38例患有TED和限制性水平斜视的患者接受了单侧或双侧内直肌后退术以缓解复视。所有患者均接受了眼球筋膜后退术，将眼球筋膜从上方的结膜分离，使其回缩至眼眶内。总体成功率为87%，再次手术率为7.9%。第一眼位和偏心注视时水平偏斜的改善具有统计学意义（p < 0.001）。在五个主要注视位置的垂直偏斜变化无统计学意义。术后垂直偏斜的变化与术前水平偏斜或水平后退量不成比例。
由于TED患者术前眼位偏斜的非共同性，术后持续存在偏心注视时的眼位不正。在TED水平斜视手术中增加眼球筋膜后退术可使第一眼位和偏心注视时的眼位对齐有统计学意义的改善。这是第一项分析TED斜视手术在第一眼位和阅读注视以外位置的术后结果的研究。作者推测增加眼球筋膜后退术松解瘢痕组织有助于这些改善。
