Xu Hui-Qing, Wang Qian, Hu Li-Li, Li Hong, Peng Feng
Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
J Ophthalmol. 2022 Sep 16;2022:6382429. doi: 10.1155/2022/6382429. eCollection 2022.
Although enhanced recovery after surgery (ERAS) was shown to improve patients' recovery after surgery and transnasal endoscopic orbital decompression has been associated with lesser risks of postoperative complications compared to other surgical techniques in treating Graves ophthalmopathy (GO), there are currently no clinical studies on the application of ERAS in transnasal endoscopic orbital decompression. This study aimed to investigate the potential effects of combining transnasal endoscopic orbital decompression with ERAS in the treatment of GO.
A retrospective analysis was performed for 5 GO patients (10 eyes) treated with transnasal endoscopic orbital decompression from January 2021 to December 2021 at the Third Affiliated Hospital of Sun Yat-Sen University. All patients underwent ERAS, and the effects of ERAS on the postoperative complications and recovery of patients were evaluated.
Ophthalmological examination showed that GO patients had good correction of exophthalmos after surgery combined with ERAS. Specifically, the exophthalmos reduction in subjects was 0.9-2.1 mm, with a mean reduction of 1.23 mm. In addition, a visual acuity improvement of 0.15-0.4, with an average improvement of 0.23, was also observed. Further, the Scale of Quality of Life for Diseases with Visual Impairment (SQOL-DVI) showed that, compared with before surgery, the patients' QOL was significantly improved 2 weeks after surgery. Before surgery, there were 2 patients with diplopia and blurred vision, and after postoperative adaptive exercise, the symptoms of these 2 patients disappeared after 6 months of follow-up. As for the other 3 patients, they had no diplopia or blurred vision after surgery.
This observational study found that transnasal endoscopic orbital decompression might be effective in treating GO, and ERAS might be considered an important adjunct to improving perioperative care and postoperative recovery.
尽管术后加速康复（ERAS）已被证明可改善患者术后恢复情况，且与其他治疗Graves眼病（GO）的手术技术相比，经鼻内镜眼眶减压术术后并发症风险较低，但目前尚无关于ERAS在经鼻内镜眼眶减压术中应用的临床研究。本研究旨在探讨经鼻内镜眼眶减压术联合ERAS治疗GO的潜在效果。
对2021年1月至2021年12月在中山大学附属第三医院接受经鼻内镜眼眶减压术治疗的5例GO患者（10只眼）进行回顾性分析。所有患者均接受ERAS治疗，并评估ERAS对患者术后并发症及恢复情况的影响。
眼科检查显示，GO患者术后联合ERAS治疗后眼球突出度得到良好矫正。具体而言，受试者眼球突出度降低0.9 - 2.1毫米，平均降低1.23毫米。此外，视力提高了0.15 - 0.4，平均提高0.23。进一步的视力障碍疾病生活质量量表（SQOL - DVI）显示，与术前相比，患者术后2周生活质量显著改善。术前有2例患者出现复视和视力模糊，术后经过适应性锻炼，随访6个月后这2例患者的症状消失。另外3例患者术后无复视或视力模糊。
本观察性研究发现，经鼻内镜眼眶减压术可能对治疗GO有效，ERAS可被视为改善围手术期护理和术后恢复的重要辅助手段。
