Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, United States of America.
Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, University of Iowa Hospitals and Clinics, United States of America.
Am J Otolaryngol. 2022 Jan-Feb;43(1):103196. doi: 10.1016/j.amjoto.2021.103196. Epub 2021 Sep 2.
To compare the indications, surgical techniques and outcomes for revision orbital decompression surgery for thyroid eye disease in open, endoscopic, and combined open and endoscopic approaches.
A retrospective review of all revision orbital decompression procedures for thyroid eye disease from a single large academic institution over a 17-year period (01/01/2004-01/01/2021) was performed. Patient demographics, as well as indications and types of surgery were reviewed. Outcome measures included changes in proptosis, intraocular pressure, visual acuity and diplopia.
Thirty procedures were performed on 21 patients. There was a median of 9.4 months between primary orbital decompression and revision decompression surgery. There were 6 bilateral procedures, and 2 of these patients underwent additional revision surgeries due to decreased visual acuity with concern for persistent orbital apex compression or sight-threatening ocular surface exposure in the setting of proptosis. Twenty-five procedures were performed as open surgeries with 5 endoscopic/combined cases. Combined Ophthalmology/Otolaryngology surgery via combined open/endoscopic approaches was favoured for persistent orbital apex disease. Visual acuity remained preserved in all patients. The overall median reduction in proptosis was 2 mm and intraocular pressure change was 1 mmHg regardless of surgical approach. The overall rate of new onset diplopia after surgery was 15%. These patients had open approaches. All endoscopic/combined approach patients had pre-existing diplopia. There were no statistically significant differences between the open and endoscopic/combined groups in regard to change in visual acuity, reduction in proptosis or intraocular pressure.
Revision orbital decompression is an uncommon procedure indicated for those patients with progressive symptoms despite previous surgery and intensive medical management. Both endoscopic and non-endoscopic techniques offer favourable outcomes with respect to visual acuity, decrease in intraocular pressure, and improvement in proptosis and overall lead to a low incidence of new onset diplopia.
Level IV.
比较甲状腺眼病行眼眶减压术修复时，开放入路、内镜入路和联合入路的适应证、手术技术和结果。
对单一大专附属医院 17 年来（2004 年 1 月 1 日-2021 年 1 月 1 日）所有因甲状腺眼病行眼眶减压术修复的患者进行回顾性研究。回顾患者的人口统计学资料、手术适应证和术式。评估指标包括眼球突出度、眼压、视力和复视的变化。
21 例患者共行 30 次手术。初次眶减压和修复性减压之间的中位时间为 9.4 个月。有 6 例为双侧手术，其中 2 例因视力下降（考虑持续眶尖受压）或眼球突出伴视力威胁性眼表暴露而行再次手术。25 例为开放手术，5 例为内镜/联合手术。联合眼科/耳鼻喉科手术通过联合开放/内镜入路用于治疗持续性眶尖疾病。所有患者视力均保持完好。总体眼球突出度平均减少 2mm，眼压变化 1mmHg，无论手术入路如何。术后新发复视的总体发生率为 15%。这些患者行开放手术，所有内镜/联合手术的患者均存在术前复视。在视力、眼球突出度减少和眼压变化方面，开放组和内镜/联合组之间无统计学差异。
对于那些尽管先前手术和强化药物治疗仍有进展性症状的患者，行眼眶减压术修复是一种少见的治疗方法。内镜和非内镜技术均可在视力、眼压降低、眼球突出度改善方面获得良好的结果，总体上导致新发复视的发生率较低。
IV 级。
