Kochetkov P A, Grusha Ya O, Svistushkin V M, Ismailova D S, Sviridenko N Yu, Duvanova E D
Sechenov First Moscow State Medical University, Moscow, Russia.
Research Institute of Eye Diseases of Russian Academy of Medical Sciences, Moscow, Russia.
Vestn Otorinolaringol. 2022;87(3):13-18. doi: 10.17116/otorino20228703113.
To develop an algorithm for the use of transnasal endoscopic orbital decompression (TEOD) in endocrine ophthalmopathy (EOP).
The results of 225 TEODs are analyzed. 139 patients with EOP were under observation, who were divided into two groups. Group 1 included 64 patients with an inactive form of EOP, group 2 included 75 patients with EOP complicated by optical neuropathy. Group 2 patients are divided into three subgroups. In the first subgroup there were 36 patients who underwent only TEDO, in the second subgroup there were 17 patients who underwent simultaneous TEOD and lateral bone orbital decompression (LBOD), in the third subgroup there were 22 patients who underwent TEOD and with an interval of 7-14 days - LBOD. After surgery, visual acuity, visual fields and color perception, regression of exophthalmos, as well as the presence of strabismus and diplopia were evaluated.
In patients of group 1 (64 patients, 104 TEODs), the average regression rate of exophthalmos was 5.49±1.22. Diplopia was observed in 23 (36%) patients, strabismus - in 18 (28%) patients. The transient nature of diplopia and strabismus was noted in 11% of cases. Patients of the first subgroup showed an increase in visual acuity from 0.4±0.28 to 0.7±0.2 (<0.05). Strabismus and diplopia were observed in 54% of cases. In the subgroup with step-by-step performed TEOD and LBOD, the increase in visual acuity was more pronounced and amounted to 74% (from 0.78±0.71 to 0.2±0.3 according to LogMAR, <0.05), postoperative strabismus and diplopia remained at a high level - 40% of the number of surgical operations performed. The best results of improving visual functions were obtained in patients of the second subgroup with simultaneous TEOD and LBOD (balanced orbital decompression): the increase in visual acuity was 79% (from 0.57±0.47 to 0.12±0.2 according to LogMAR, <0.05). In patients of this subgroup, strabismus develops less frequently (22% of the number of operated orbits).
Transnasal endoscopic decompression of the orbit in the inactive form of the disease is indicated for exophthalmos of more than 4-8 mm. In optical neuropathy, transnasal endoscopic orbital decompression is indicated regardless of the initial visual acuity of the patient and should be supplemented with lateral bone orbital decompression with visual acuity below 0.1. The obtained results allowed us to form an algorithm for surgical treatment of patients with endocrine ophthalmopathy and optical neuropathy using transnasal endoscopic orbital decompression as a surgical intervention.
开发一种在内分泌性眼病（EOP）中使用经鼻内镜眼眶减压术（TEOD）的算法。
分析225例TEOD的结果。观察139例EOP患者，将其分为两组。第1组包括64例非活动型EOP患者，第2组包括75例并发视神经病变的EOP患者。第2组患者分为三个亚组。第一个亚组有36例仅接受TEDO的患者，第二个亚组有17例同时接受TEOD和外侧眶壁减压术（LBOD）的患者，第三个亚组有22例接受TEOD且间隔7 - 14天再接受LBOD的患者。术后评估视力、视野和色觉、眼球突出的消退情况，以及斜视和复视的存在情况。
第1组患者（64例，104次TEOD），眼球突出的平均消退率为5.49±1.22。23例（36%）患者出现复视，18例（28%）患者出现斜视。11%的病例中复视和斜视呈短暂性。第一个亚组患者的视力从0.4±0.28提高到0.7±0.2（<0.05）。54%的病例中观察到斜视和复视。在逐步进行TEOD和LBOD的亚组中，视力提高更为明显，达到74%（根据LogMAR从0.78±0.71提高到0.2±0.3，<0.05），术后斜视和复视仍处于较高水平——占手术操作次数的40%。在同时进行TEOD和LBOD（平衡眼眶减压）的第二个亚组患者中获得了改善视觉功能的最佳结果：视力提高了79%（根据LogMAR从0.57±0.47提高到0.12±0.2，<0.05）。该亚组患者中斜视的发生率较低（占手术眼眶数的22%）。
对于非活动型疾病，当眼球突出超过4 - 8 mm时，经鼻内镜眼眶减压术是适用的。在视神经病变中，无论患者初始视力如何，经鼻内镜眼眶减压术都是适用的，并且当视力低于0.1时应辅以外侧眶壁减压术。所获得的结果使我们能够形成一种以内分泌性眼病和视神经病变患者为对象，使用经鼻内镜眼眶减压术作为手术干预的手术治疗算法。
