Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
Int J Oral Maxillofac Surg. 2019 Apr;48(4):461-467. doi: 10.1016/j.ijom.2018.08.016. Epub 2018 Nov 12.
The aim of this study was to compare the surgical outcomes of deep lateral orbital decompression using the rim-sparing technique versus the rim-removal technique in Graves' orbitopathy (GO). A retrospective cohort study of 75 orbits in 50 patients with GO was performed. Proptosis, best corrected visual acuity (BCVA), intraocular pressure (IOP), upper and lower lid margin to reflex distances (MRD-1 and MRD-2, respectively), diplopia, ocular restriction, and GO quality of life (GO-QOL) questionnaire results were analyzed pre- and postoperatively. The average proptosis reduction ranged from 3.5mm to 6.7mm with the rim-sparing technique and from 3.6mm to 6.7mm with the rim-removal technique (P>0.05). All orbits with dysthyroid optic neuropathy in the rim-sparing group and 87.5% of such orbits in the rim-removal group showed improved BCVA (P=0.321). Reductions in IOP, MRD-1, and MRD-2 were observed with both techniques. Patients in the rim-sparing group had greater improvements in GO-QOL appearance score (P=0.043). In conclusion, rim-sparing orbital decompression provides efficacious outcomes with greater improvements in patient quality of life than the rim-removal technique. The rim-sparing technique should be considered as a preferable option because it preserves the integrity of the lateral vertical maxillary buttress and bony protection for the orbital contents.
本研究旨在比较边缘保留技术与边缘切除技术在格雷夫斯眼病（GO）中的深外侧眶减压手术效果。对 50 例 GO 患者的 75 只眼眶进行了回顾性队列研究。分析了术前和术后的突出度、最佳矫正视力（BCVA）、眼压（IOP）、上睑和下睑缘至反射距离（MRD-1 和 MRD-2）、复视、眼球运动受限和 GO 生活质量（GO-QOL）问卷结果。边缘保留技术的平均突出度从 3.5mm 减少到 6.7mm，边缘切除技术的平均突出度从 3.6mm 减少到 6.7mm（P＞0.05）。边缘保留组中所有甲状腺相关眼病性视神经病变的眼眶，以及边缘切除组中 87.5%的眼眶，BCVA 均有所改善（P=0.321）。两种技术均观察到 IOP、MRD-1 和 MRD-2 的降低。边缘保留组的 GO-QOL 外观评分改善更大（P=0.043）。总之，边缘保留眶减压术提供了有效的结果，与边缘切除技术相比，患者的生活质量有了更大的改善。由于边缘保留技术保留了外侧垂直上颌骨支柱的完整性和眶内容物的骨性保护，因此应将其视为一种更优的选择。
