Guo Jie, Li Xiaofeng, Ma Ruiqi, Qian Jiang
Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
NHC Key Laboratory of Myopia (Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, No. 83 Fenyang Road, Shanghai, 200031, China.
BMC Ophthalmol. 2021 Mar 12;21(1):134. doi: 10.1186/s12886-021-01892-9.
Postoperative ocular imbalance is an important problem for orbital decompression surgery in thyroid eye disease (TED). The aim of this study was to evaluate the changes in unilateral ocular deviation and duction following orbital decompression and discuss the biomechanics of ocular imbalance.
Fifty-four TED patients who underwent unilateral orbital decompression were included. Fifteen patients underwent 1-wall (deep lateral wall) decompression, 18 patients underwent 2-wall (deep lateral and medial wall) decompression and 21 patients underwent 3-wall (deep lateral, medial and inferior wall) decompression. Objective and subjective deviation of the operated eyes were evaluated using the prism test and synoptophore, respectively. Ocular ductions were measured using Hirschberg's method. The diameters of the extraocular rectus were measured by computed tomography.
Ocular deviation and duction showed no significant difference after 1-wall decompression (p = 0.25-0.89). Esotropia increased after 2-wall decompression (p = 0.001-0.02), and hypotropia increased after 3-wall decompression (p = 0.02). Adduction increased but abduction decreased following 2-wall and 3-wall decompression (p < 0.05). Infraduction increased following 3-wall decompression (p < 0.001). Additionally, the increase in esotropia was significantly correlated with the increase in adduction and with the decrease in abduction (r = 0.37-0.63, p < 0.05). There were significant correlations between the diameter of the medial rectus and the increase in esotropia, the increase in adduction and the decrease in abduction postoperatively (r = 0.35-0.48, p < 0.05).
The changes in ocular deviation and duction were different after 1-wall, 2-wall and 3-wall orbital decompression. The increased contractile force of the rectus may be an important reason for strabismus changes after orbital decompression surgery.
术后眼球失衡是甲状腺眼病（TED）眼眶减压手术中的一个重要问题。本研究的目的是评估眼眶减压后单侧眼球偏斜和眼球运动的变化，并探讨眼球失衡的生物力学机制。
纳入54例行单侧眼眶减压的TED患者。15例患者接受1壁（外侧深壁）减压，18例患者接受2壁（外侧和内侧深壁）减压，21例患者接受3壁（外侧、内侧和下壁深壁）减压。分别使用三棱镜试验和同视机评估术眼的客观和主观偏斜。采用 Hirschberg 法测量眼球运动。通过计算机断层扫描测量眼外直肌的直径。
1壁减压后眼球偏斜和眼球运动无显著差异（p = 0.25 - 0.89）。2壁减压后内斜视增加（p = 0.001 - 0.02），3壁减压后下斜视增加（p = 0.02）。2壁和3壁减压后内转增加但外转减少（p < 0.05）。3壁减压后下转增加（p < 0.001）。此外，内斜视的增加与内转的增加和外转的减少显著相关（r = 0.37 - 0.63，p < 0.05）。术后内直肌直径与内斜视的增加、内转的增加和外转的减少之间存在显著相关性（r = 0.35 - 0.48，p < 0.05）。
1壁、2壁和3壁眼眶减压后眼球偏斜和眼球运动的变化不同。直肌收缩力增加可能是眼眶减压手术后斜视变化的重要原因。
