Military Medical Academy, Sofia, Bulgaria.
Folia Med (Plovdiv). 2020 Sep 30;62(3):462-467. doi: 10.3897/folmed.62.e49313.
Graves' ophthalmopathy (GO) is the most common and difficult-to-treat extrathyroidal symptom of Graves' disease. Though retraction of the upper eyelid is the most common clinical feature of GO, it can have a much more severe clinical manifesta-tion with symptoms such as conjunctival chemosis, keratopathy, extraocular muscle dysfunction, proptosis of the bulb and dysthyroid optic neuropathy. Treatment methods include control of the thyroid function, corticosteroid and immunosuppressive therapy as well as radiotherapy. These approaches are ineffective in one-third of cases, with patients being refractory to all aforementioned therapeutic modalities. In these cases, surgical decompression of the orbit is in order.The spectrum of surgical techniques is wide and varies from decompression of the lateral wall of the orbit to decompression via removal of all four orbital walls. The aim of the current study was to evaluate the results of superolateral orbital decompression.
The study is retrospective and covers the period from January 2009 to January 2019. During that period eight patients with Graves' ophthalmopathy underwent surgery and were followed up in the Department of Neurosurgery in the Mili-tary Medical Academy, Sofia. The mean age of the patients was 57 years, with the youngest being 30 years old and the oldest - 74 years old. The gender distribution was 1.6/1 with predominance in females (5 women and 3 men). The surgical approach we used is a com-bination of lateral and upper orbitotomy and was described in detail by Al-Mefty. All of patients underwent ophthalmic examinations in the pre- and postoperative period, with special attention to their visual acuity, the condition of the eyelid and the width of the ocular slit. Exophthalmometry was obtained via Hertel's method. The participants in this study are followed for a period of six months after the operation.
All eight patients underwent superolateral orbitotomy. There were a total of ten orbital decompressions. Improvement of visual acuity and reduction of the proptosis were reported in all other surgically treated patients. The mean reported improvement of visual acuity (measured via Snellen's method) was 0.27±0.17. The mean reported a reduction of proptosis was 7.53±2.58 mm.
Although the surgical techniques for orbital decompression we used have significant disadvantages, they remain the only alternative in order to avoid the complication of severe GO.
甲状腺眼病（GO）是 Graves 病最常见且最难治疗的甲状腺外症状。虽然上睑退缩是 GO 最常见的临床特征，但它可能有更严重的临床表现，如结膜水肿、角膜病变、眼外肌功能障碍、球突出和甲状腺相关视神经病变。治疗方法包括控制甲状腺功能、皮质类固醇和免疫抑制治疗以及放射治疗。这些方法在三分之一的病例中无效，患者对所有上述治疗方法均有抗药性。在这些情况下，需要进行眼眶减压手术。手术技术范围广泛，从眼眶外侧壁减压到通过去除所有四个眼眶壁进行减压。本研究的目的是评估超外侧眼眶减压术的结果。
该研究是回顾性的，涵盖了 2009 年 1 月至 2019 年 1 月期间的时间段。在此期间，8 例 Graves 眼病患者在索菲亚军事医学科学院神经外科接受了手术治疗，并接受了随访。患者的平均年龄为 57 岁，年龄最小的为 30 岁，年龄最大的为 74 岁。性别分布为 1.6/1，女性居多（5 名女性和 3 名男性）。我们使用的手术方法是外侧和上眶切开术的组合，由 Al-Mefty 详细描述。所有患者在术前和术后都进行了眼科检查，特别注意他们的视力、眼睑状况和眼裂宽度。通过 Hertel 法获得眼球突出度。本研究的参与者在手术后 6 个月内进行随访。
所有 8 例患者均行超外侧眶切开术。共进行了 10 次眼眶减压术。所有接受手术治疗的患者均报告视力改善和眼球突出度减小。报告的平均视力改善（通过 Snellen 法测量）为 0.27±0.17。报告的平均眼球突出度减小为 7.53±2.58 毫米。
尽管我们使用的眼眶减压手术技术有明显的缺点，但它们仍然是避免严重 GO 并发症的唯一选择。
