Horn Maren, Schittkowski Michael P
Klinik für Augenheilkunde, Bereich Strabologie, Neuroophthalmologie und okuloplastische Chirurgie, Universitätsmedizin Göttingen.
Klin Monbl Augenheilkd. 2019 Jan;236(1):17-24. doi: 10.1055/a-0802-9275. Epub 2019 Jan 28.
Graves' orbitopathy is the most common extrathyroidal manifestation of Graves' disease. In the burnt out fibrotic phase exophthalmos, diplopia and lid retraction may remain, which can require multiple rehabilitative surgical interventions. Orbital decompression is an established surgical procedure for the treatment of exophthalmos in Graves' orbitopathy. The aim of the study was to evaluate the efficacy and side effects of the deep lateral orbital wall decompression including the orbital rim.
In this retrospective, non-comparative case series, all patients with Graves' orbitopathy, who underwent lateral orbital wall decompression at the Eye Clinic of the University of Göttingen between 2008 and 2015, were analysed in terms of exophthalmos reduction, diplopia (Gorman score) and complications. The surgical technique involved the removal of the lateral orbital wall including the orbital rim combined with additional orbital fat resection via swinging eyelid approach.
127 patients who underwent 195 orbital decompressions were included. Mean exophthalmos reduction was 4.0 ± 1.2 mm (range 1.5 - 7.5 mm). Preoperatively, 47 patients/77 orbits (37.0/39.5%) presented without diplopia. Postoperatively, 3 patients/3 orbits (6.4/3.9%) showed new-onset diplopia (2.4% of all patients, 1.5% of all orbits). Diplopia in primary gaze was noted in one of the 3 patients (0.8% of all patients, 2.1% of patients without preoperative diplopia), and inconstant diplopia was seen in the other 2 patients. Postoperative improvement of diplopia was noted in 19 patients/19 orbits (15.0% of all patients, 23.8% of patients with preoperative diplopia/9.7% of all 195 interventions), and 16.1% of cases with preexisting diplopia. No severe complications were seen, except for one case of postoperative bleeding, which was successfully managed surgically without any functional deficits. A visible scar formation was noted in 6 cases (3.1%), temporal hollowing in 3 cases (1.5%), oscillopsia when chewing in 3 cases (1.5%) and a de-insertion of the lateral canthal region in 2 cases (1%).
Deep lateral orbital wall decompression, including the orbital rim, is an effective surgical technique to reduce exophthalmos in patients with Graves' orbitopathy with a low risk of functional and aesthetic complications.
Graves眼病是Graves病最常见的甲状腺外表现。在疾病晚期纤维化阶段，眼球突出、复视和眼睑退缩可能持续存在，这可能需要多次康复性手术干预。眼眶减压术是治疗Graves眼病眼球突出的一种成熟手术方法。本研究的目的是评估包括眶缘在内的外侧眶壁深层减压术的疗效和副作用。
在这个回顾性、非对照病例系列中，对2008年至2015年间在哥廷根大学眼科诊所接受外侧眶壁减压术的所有Graves眼病患者进行了分析，评估其眼球突出度降低情况、复视（Gorman评分）和并发症。手术技术包括切除包括眶缘在内的外侧眶壁，并通过摆动眼睑入路额外切除眶脂肪。
纳入了127例行195次眼眶减压术的患者。平均眼球突出度降低4.0±1.2mm（范围1.5 - 7.5mm）。术前，47例患者/77只眼眶（37.0/39.5%）无复视。术后，3例患者/3只眼眶（6.4/3.9%）出现新发复视（占所有患者的2.4%，占所有眼眶的1.5%）。3例患者中有1例在第一眼位出现复视（占所有患者的0.8%，占术前无复视患者的2.1%），另外2例出现间歇性复视。19例患者/19只眼眶（占所有患者的15.0%，占术前有复视患者的23.8%/占所有195次手术的9.7%）的复视得到术后改善，术前有复视的病例中这一比例为16.1%。除1例术后出血病例外，未见严重并发症，该出血病例经手术成功处理，未遗留任何功能缺陷。6例（3.1%）出现可见瘢痕形成，3例（1.5%）出现颞部凹陷，3例（1.5%）咀嚼时出现视振荡，2例（1%）出现外眦部附着处分离。
包括眶缘在内的外侧眶壁深层减压术是一种有效的手术技术，可降低Graves眼病患者的眼球突出度，且功能和美学并发症风险较低。
