Dev S, Damji K F, DeBacker C M, Cox T A, Dutton J J, Allingham R R
Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA.
Can J Ophthalmol. 1998 Oct;33(6):314-9.
The effect of thyroid orbitopathy on intraocular pressure (IOP) remains controversial. We carried out a study to determine the effect of orbital decompression surgery on the IOP in patients with advanced thyroid orbitopathy.
The records of 12 consecutive patients (22 eyes) who underwent decompression surgery for severe thyroid orbitopathy between 1985 and 1996 were reviewed. All patients were maintained on essentially the same medications before and after surgery. The IOP readings, obtained by means of applanation tonometry in primary gaze, from the pre- and postoperative visits were recorded, and the net change was calculated.
The mean preoperative and postoperative IOP values were 19.8 mm Hg and 16.8 mm Hg respectively, a significant difference (p = 0.008). Seven of eight eyes with an IOP of 21 mm Hg or greater preoperatively had a postoperative IOP less than 21 mm Hg; these eyes showed a mean decrease in IOP of 5.6 mm Hg. The degree of preoperative IOP elevation was found to be a strong predictor of the amount of IOP lowering after surgery (p = 0.014).
Our results support the concept that orbital congestion associated with thyroid orbitopathy produces an increase in IOP by elevation of episcleral venous pressure (EVP) and that orbital decompression may reduce the IOP by decreasing EVP. Decompression surgery may obviate the need for more aggressive management of glaucoma in patients with severe thyroid orbitopathy.
甲状腺眼病对眼压（IOP）的影响仍存在争议。我们开展了一项研究，以确定眼眶减压手术对晚期甲状腺眼病患者眼压的影响。
回顾了1985年至1996年间连续12例（22只眼）因严重甲状腺眼病接受减压手术患者的记录。所有患者在手术前后基本使用相同的药物。记录术前和术后在第一眼位通过压平眼压计测得的眼压读数，并计算净变化。
术前和术后眼压的平均值分别为19.8 mmHg和16.8 mmHg，差异有统计学意义（p = 0.008）。术前眼压为21 mmHg或更高的8只眼中，有7只眼术后眼压低于21 mmHg；这些眼的眼压平均下降了5.6 mmHg。术前眼压升高程度被发现是术后眼压降低幅度的有力预测指标（p = 0.014）。
我们的结果支持这样的观点，即与甲状腺眼病相关的眼眶充血通过升高巩膜静脉压（EVP）导致眼压升高，而眼眶减压可能通过降低EVP来降低眼压。减压手术可能避免对严重甲状腺眼病患者进行更积极的青光眼治疗。
