Tu Yunhai, Xu Mingna, Kim Andy D, Wang Michael T M, Pan Zhaoqi, Wu Wencan
The Eye Hospital of Wenzhou Medical University, No. 270 Xueyuan Xi Road, Wenzhou, Zhejiang, 325027, P. R. China.
Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
Eye Vis (Lond). 2021 Apr 28;8(1):19. doi: 10.1186/s40662-021-00238-2.
To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.
In this retrospective research, forty-two subjects (74 orbits) who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled. Preoperative and postoperative best-corrected visual acuity (BCVA), visual field mean deviation (MD), Hertel exophthalmometry, and new onset diplopia were assessed before and after the intervention. The Wilcoxon test was used for differential analysis. Linear mixed-models' analyses were conducted to assess the potential predictors for BCVA change.
Postoperatively, the mean BCVA improved from 0.70 ± 0.62 logMAR to 0.22 ± 0.33 logMAR. BCVA significantly improved in 69 eyes (93%), remained stable in 4 eyes (5%) and deteriorated in 1 eye (1%). MD of visual fields improved from -13.73 ± 9.22 dB to -7.23 ± 7.04 dB. Proptosis decreased from 19.57 ± 3.38 mm to 16.35 ± 3.01 mm. Preoperative BCVA, MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA (P < 0.05) by linear mixed-models' analyses. Eighteen patients (42.9%) developed new diplopia postoperatively.
Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.
描述改良内镜经鼻眶尖减压术治疗甲状腺功能异常性视神经病变的手术技术，并评估其临床疗效及安全性。
本回顾性研究纳入了42例（74眼）接受改良内镜经鼻眶尖减压术治疗甲状腺功能异常性视神经病变的患者。在干预前后评估最佳矫正视力（BCVA）、视野平均缺损（MD）、Hertel眼球突出度测量值以及新发复视情况。采用Wilcoxon检验进行差异分析。进行线性混合模型分析以评估BCVA变化的潜在预测因素。
术后，平均BCVA从0.70±0.62 logMAR提高至0.22±0.33 logMAR。69眼（93%）的BCVA显著改善，4眼（5%）保持稳定，1眼（1%）恶化。视野MD从-13.73±9.22 dB改善至-7.23±7.04 dB。眼球突出度从19.57±3.38 mm降至16.35±3.01 mm。通过线性混合模型分析，术前BCVA、视野MD和内直肌直径是与BCVA改善相关的独立因素（P<0.05）。18例患者（42.9%）术后出现新发复视。
改良内镜经鼻眶尖减压术能有效恢复甲状腺功能异常性视神经病变患者的视力。
