L.J. Eye Institute, Ambala, India.
Royal Adelaide Hospital, Adelaide, Australia.
Eye (Lond). 2019 Oct;33(10):1613-1618. doi: 10.1038/s41433-019-0464-5. Epub 2019 May 8.
To describe a modified technique of endoscopic orbital decompression for dysthyroid optic neuropathy nonresponsive to pulsed corticosteroids.
Retrospective, interventional single centre case series included 17 consecutive patients with dysthyroid optic neuropathy (DON) who were refractory to pulse corticosteroids. Removal of the posteromedial floor and the orbital process of palatine bone (OPPB) was performed in addition to the endoscopic transethmoidal medial orbital wall decompression (ETMOWD), to achieve maximal orbital apex decompression. Main outcome measures were change in visual acuity (VA), color vision, degree of proptosis reduction, incidence of new-onset diplopia, and any complications.
Seventeen eyes (100%) had a statistically significant improvement in VA from 1.0 ± 0.44 LogMAR to 0.0 ± 0.15, with an average improvement of 0.41 ± 0.30 LogMAR (p 0.05, paired t-test). Fourteen out of 16 eyes had a complete improvement in color vision and two eyes had partial recovery. Afferent pupillary defect (76.5%) resolved in all cases. Five out of 10 cases with preoperative visual field defects demonstrated no residual field defects following surgery. The range of proptosis reduction was 0-5 mm (mean 2.7 ± 1.3 mm). No patients with diplopia (12/17) had worsening or developed new-onset diplopia following surgery.
Combined removal of the posterior medial floor including the OPPB with ETMOWD may be a viable alternative in the surgical management of DON.
描述一种改良的内镜眶减压术治疗对脉冲皮质类固醇治疗无反应的甲状腺相关眼病性视神经病变。
回顾性、干预性单中心病例系列研究纳入了 17 例甲状腺相关眼病性视神经病变（DON）患者，这些患者对脉冲皮质类固醇治疗无反应。除了经鼻内镜眶内侧壁减压术（ETMOWD）外，还进行了后内侧眶底和腭骨眶突（OPPB）的切除，以实现眶尖的最大减压。主要观察指标为视力（VA）、色觉、眼球突出度的改善程度、新发复视的发生率以及任何并发症。
17 只眼（100%）的 VA 有统计学意义的改善，从 1.0±0.44 LogMAR 提高到 0.0±0.15，平均提高了 0.41±0.30 LogMAR（p<0.05，配对 t 检验）。16 只眼中有 14 只的色觉完全改善，2 只的色觉部分恢复。所有病例的传入性瞳孔障碍（76.5%）均得到缓解。术前视野缺损的 5 例中有 2 例术后无残留视野缺损。眼球突出度的改善范围为 0-5mm（平均 2.7±1.3mm）。17 例复视患者中，无 5 例（12/17）在手术后出现复视加重或新发复视。
在 DON 的手术治疗中，联合切除后内侧眶底包括 OPPB 与 ETMOWD 可能是一种可行的选择。
