Grusha Y O, Kochetkov P A, Danilov S S, Duvanova E D, Sviridenko N Yu
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Krasnov Research Institute of Eye Diseases, Moscow, Russia.
Vestn Oftalmol. 2023;139(3):63-68. doi: 10.17116/oftalma202313903163.
The study evaluates the frequency of complications after transnasal endoscopic orbital decompression (TEOD).
The study included 40 patients (75 orbits) with thyroid eye disease (TED; also termed Graves' ophthalmopathy, GO; thyroid-associated orbitopathy, TAO), who were divided into three groups depending on the method of surgical treatment. The first group consisted of 12 patients (21 orbits) who were treated with TEOD as the only method of surgical treatment. In the second group, there were 9 patients (18 orbits) who underwent TEOD and lateral orbital decompression (LOD) simultaneously. The third group consisted of 19 patients (36 orbits) who underwent TEOD as the second stage after LOD. Pre- and postoperative observation included assessment of visual acuity, visual field, exophthalmos, heterotropia/heterophoria angle.
In group I the new-onset strabismus with binocular double vision was detected in 1 patient (8.3%). In 5 patients (41.7%), there was an increase in the angle of deviation and an increase in diplopia. In group II the new-onset strabismus with diplopia occurred in 2 patients (22.2%). In 8 patients (88.9%), an increase in the angle of deviation and an increase in diplopia were revealed. In group III the new-onset strabismus and diplopia occurred in 4 patients (21.0%). An increase in the deviation angle and an increase in diplopia were noted in 8 patients (42.1%). The number of postoperative otorhinolaryngologic complications in group I was 4 (19.0% of the number of orbits). Two intraoperative complications were recorded in group II - 1 case of cerebrospinal rhinorrhea (5.5% of the number of orbits) and 1 case of retrobulbar hematoma without permanent vision loss (5.5% of the number of orbits). The number of postoperative complications was 3 (16.7% of the number of orbits). In group III the number of postoperative complications was 3 (8.3% of the number of orbits).
The study showed that the most common ophthalmological complication after TEOD is strabismus with binocular double vision. Otorhinolaryngologic complications included synechiae of the nasal cavity, sinusitis and mucocele of the paranasal sinuses.
本研究评估经鼻内镜眼眶减压术（TEOD）后并发症的发生率。
本研究纳入40例（75只眼眶）甲状腺眼病（TED；也称为Graves眼病，GO；甲状腺相关性眼眶病，TAO）患者，根据手术治疗方法分为三组。第一组由12例（21只眼眶）患者组成，他们接受TEOD作为唯一的手术治疗方法。第二组有9例（18只眼眶）患者同时接受了TEOD和外侧眼眶减压术（LOD）。第三组由19例（36只眼眶）患者组成，他们在LOD后接受TEOD作为第二阶段治疗。术前和术后观察包括视力、视野、眼球突出度、斜视/隐斜角度的评估。
第一组中，1例患者（8.3%）出现新发斜视伴双眼复视。5例患者（41.7%）出现斜视度数增加和复视加重。第二组中，2例患者（22.2%）出现新发斜视伴复视。8例患者（88.9%）出现斜视度数增加和复视加重。第三组中，4例患者（21.0%）出现新发斜视和复视。8例患者（42.1%）出现斜视度数增加和复视加重。第一组术后耳鼻咽喉科并发症的数量为4例（占眼眶数量的19.0%）。第二组记录了2例术中并发症——1例脑脊液鼻漏（占眼眶数量的5.5%）和1例球后血肿但无永久性视力丧失（占眼眶数量的5.5%）。术后并发症的数量为3例（占眼眶数量的16.7%）。第三组术后并发症的数量为3例（占眼眶数量的8.3%）。
本研究表明，TEOD后最常见的眼科并发症是斜视伴双眼复视。耳鼻咽喉科并发症包括鼻腔粘连、鼻窦炎和鼻窦黏液囊肿。
