Bengoa-González Álvaro, Galindo-Ferreiro Alicia, Mencía-Gutiérrez Enrique, Sánchez-Tocino Hortensia, Martín-Clavijo Agustín, Lago-Llinás María-Dolores
Ophthalmology Department, 12 de Octubre Hospital, Complutense University, 28041 Madrid, Spain.
Ophthalmology Department, Rio Hortega Hospital, Valladolid University, 47012 Valladolid, Spain.
J Ophthalmol. 2019 Dec 2;2019:9478512. doi: 10.1155/2019/9478512. eCollection 2019.
To describe the results of thyroid-related orbitopathy (TRO) treated by ultrasonic deep lateral wall bony decompression with partial rim sparing (DLW-PRS).
A review was carried out, from January 2015 to September 2017, of all patients treated with ultrasonic DLW-PRS decompression using a SONOPET® (Stryker, Kalamazoo, MI, USA) ultrasonic aspirator, using a lateral, small triangle flap incision for access. The primary outcome was the change in proptosis (measured by the difference in Hertel exophthalmometry measurements). Other secondary outcomes were changes in visual acuity (VA) (using Snellen scale, decimal fraction), presence of lagophthalmos, eyelid retraction (measured by upper eyelid margin distance to the corneal reflex (MRD) and lower eyelid margin distance to the corneal reflex (MRD), and presence of exposure keratopathy).
A total of 58 orbital decompressions in 35 patients were reviewed, with 23 patients (65.7%) having bilateral decompressions. There was a female preponderance with 26 patients (74.2%), and the mean age ± standard deviation was 52.6 ± 13.9 years. Mean proptosis was 24.51 ± 1.76 mm preoperatively, reduced to 19.61 ± 1.27 mm in final follow-up. The mean reduction was 4.9 ± 1.54 mm. VA improved from 0.8 ± 0.14 to 0.9 ± 0.12, =0.039. 5 of 13 patients (38.4%) with preoperative diplopia reported improvement or complete resolution after surgery. MRD was reduced from 5.25 ± 0.88 mm to 4.49 ± 0.7 mm. MRD was also reduced from 6.3 ± 0.88 mm to 5.0 ± 0.17 mm. Presence of lagophthalmos was reduced from 35 eyes (60.3%) to five (8.6%); the presence of epiphora was also reduced from 20 patients (57.1%) to 3 (8.5%) following decompression. Complications of the surgery included zygomatic hypoaesthesia in 14 (40%) patients in the early postoperative period and chewing alterations in 10 (28.5%) of the patients. All of these complications were resolved at the 6-month follow-up visit. We noted no surgical complications such as ocular or soft tissue damage, infection, inflammation, or visual loss.
The SONOPET® ultrasonic bone curette can be used safely and effectively for DLW orbital decompression surgery. The main benefits were good visualization and handling of tissues and speed and ease of use of the equipment. This trial is registered with ClinicalTrials.gov identifier: NCT04025034.
描述采用超声辅助眶外侧壁部分眶缘保留减压术（DLW-PRS）治疗甲状腺相关眼病（TRO）的效果。
回顾2015年1月至2017年9月期间，所有使用SONOPET®（史赛克公司，美国密歇根州卡拉马祖）超声吸引器进行超声辅助DLW-PRS减压术治疗的患者。采用外侧小三角形皮瓣切口入路。主要观察指标为眼球突出度的变化（通过Hertel眼球突出计测量差值）。其他次要观察指标包括视力（VA）变化（采用Snellen视力表、小数记录法）、兔眼的存在情况、眼睑退缩（通过上睑缘至角膜反射距离（MRD）及下睑缘至角膜反射距离（MRD）测量）以及暴露性角膜病变的存在情况。
共回顾了35例患者的58次眶减压手术，其中23例患者（65.7%）接受了双侧减压。女性患者居多，共26例（74.2%），平均年龄±标准差为52.6±13.9岁。术前平均眼球突出度为24.51±1.76mm，末次随访时降至19.61±1.27mm。平均降低了4.9±1.54mm。视力从0.8±0.14提高至0.9±0.12，P=0.039。13例术前有复视的患者中，5例（38.4%）术后报告复视改善或完全缓解。上睑MRD从5.25±0.88mm降至4.49±0.7mm。下睑MRD也从6.3±0.88mm降至5.0±0.17mm。兔眼的发生率从35只眼（60.3%）降至5只眼（8.6%）；泪溢的发生率也从20例患者（57.1%）降至3例（8.5%）。手术并发症包括术后早期14例（40%）患者出现颧骨感觉减退，10例（28.5%）患者出现咀嚼功能改变。所有这些并发症在6个月随访时均已缓解。我们未发现眼部或软组织损伤、感染、炎症或视力丧失等手术并发症。
SONOPET®超声骨锉可安全有效地用于DLW眶减压手术。主要优点是组织可视化和操作良好，以及设备使用速度快且简便。本试验已在ClinicalTrials.gov注册，标识符为：NCT04025034。
