Li Y W, Yang S Q, Zhang W, Guo X
Tianjin Eye Hospital, Tianjin Key Lab. of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin 300020, China, is a doctor of continuing education, working at the Department of Ophthalmology, the First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China.
Zhonghua Yan Ke Za Zhi. 2020 Mar 11;56(3):183-188. doi: 10.3760/cma.j.issn.0412-4081.2020.03.005.
To evaluate the effect of extraocular muscle surgery in treating secondary esotropia with diplopia after orbital decompression for thyroid-associated ophthalmopathy (TAO). Retrospective case series study. Eleven secondary esotropic patients with diplopia after orbital decompression for TAO who underwent extraocular muscle surgery during March 2016 and October 2018 in Tianjin Eye Hospital were included. All patients had new onset esotropia after decompression surgery and underwent strabismus surgery. Deviation angle, diplopia, and ocular movement were observed preoperatively and postoperatively. Surgeries were carried out under the monitored anesthesia care combined with local anesthesia, and the eye alignment was adjusted to orthotropia with no diplopia in the operation with the technique of intraoperative adjustable suture and forced duction test results. All the patients were followed up. The ages of the patients were from 26 to 42 years (1 male and 10 females). The deviation angles were 10-98 prism diopter. Orbital CT scan showed that the horizontal rectus thickness was increased at different levels, and the thickness of the medial rectus was increased more than that of the lateral rectus. Two patients had monocular medial rectus recession only, 2 had bilateral medial rectus recession only, 2 had monocular medial rectus recession combined with lateral rectus resection, and the other 5 had bilateral medial rectus recession with monocular lateral rectus resection. The recession of medial rectus muscle was 3.5 to 7.5 mm in 11 patients and 2.0 to 6.0 mm in 7 patients with the resection of lateral rectus muscle. Diplopia of the 11 patients disappeared with orthotropia at primary gaze position after the extraocular muscle surgery. The limitation of abduction changed from preoperative (-1.91±1.04) to postoperative (-0.64±0.81). All the patients were satisfied with the surgical results. At the end of the follow-up (6 to 24 months), the results of the patients were stable, and no over-correction was found. Extraocular muscle surgery with intraoperative adjustable suture technique can effectively treat TAO patients with secondary esotropia with diplopia after orbital decompression. -.
评估甲状腺相关眼病（TAO）眼眶减压术后眼外肌手术治疗继发性内斜视伴复视的效果。回顾性病例系列研究。纳入2016年3月至2018年10月在天津眼科医院接受眼外肌手术的11例TAO眼眶减压术后继发性内斜视伴复视患者。所有患者减压术后出现新发内斜视并接受斜视手术。观察术前和术后的斜视度、复视及眼球运动情况。手术在监护麻醉联合局部麻醉下进行，术中采用可调缝线技术和强制牵拉试验结果，将眼位调整至正位且无复视。所有患者均获随访。患者年龄26～42岁（男1例，女10例）。斜视度为10～98三棱镜度。眼眶CT扫描显示不同水平的水平直肌厚度增加，内侧直肌厚度增加比外侧直肌更明显。2例仅行单眼内侧直肌后徙术，2例仅行双眼内侧直肌后徙术，2例单眼内侧直肌后徙联合外侧直肌切除术，另5例双眼内侧直肌后徙联合单眼外侧直肌切除术。11例患者内侧直肌后徙量为3.5～7.5mm，7例外侧直肌切除患者外侧直肌后徙量为2.0～6.0mm。眼外肌手术后11例患者复视消失，第一眼位眼位正位。外展受限由术前的（-1.91±1.04）改善为术后的（-0.64±0.81）。所有患者对手术效果满意。随访末期（6～24个月），患者结果稳定，未发现过矫情况。术中可调缝线技术的眼外肌手术可有效治疗TAO眼眶减压术后继发性内斜视伴复视患者。
