改良内镜辅助眶内外壁减压治疗活动期难治性Graves眼病视神经病变的临床效果

Clinical effect of modified endoscope-assisted decompression of the inner and outer orbital walls in the treatment of optic neuropathy with refractory Graves ophthalmopathy in active stage

目的探讨改良内镜辅助眶内外壁减压治疗活动期难治性Graves眼病视神经病变的远期效果。方法对2017年3月~2019年3月中山大学孙逸仙纪念医院甲状腺眼病多学科诊疗组收治的9例激素冲击后视力恶化的患者行急诊减压手术,采用内镜辅助内壁减压联合经重睑延长切口的内镜辅助深外侧壁减压的个体化手术。观察术后1年患者临床活动性评分(clinical activity score,CAS)、视力、眼内压、眼球突出度及生活质量等指标。应用SPSS 26.0软件对数据进行统计学分析。结果术后随访1年以上,患者CAS分值、视力、眼压、眼球突出度及生活质量改善,差异有统计学意义。术后1年仍有复视3例,斜视3例。结论个体化改良内镜辅助的深外侧壁联合内侧壁减压手术对活动期难治性Graves眼病视神经病变具有肯定疗效。

OBJECTIVE To investigate the long term effect of modified endoscope-assisted decompression of the inner and outer orbital walls in the treatment of active optic neuropathy with refractory Graves ophthalmopathy.METHODS From March 2017 to March 2019,9 patients whose vision deteriorated after hormone shock were treated by the multidisciplinary diagnosis and treatment group of thyroid associated ophthalmopathy and underwent emergent individualized endoscopic-assisted deep lateral wall decompression through double eyelid extended incision.The CAS score,visual acuity,intraocular pressure,exophthalmos and quality of life were measured over 1 year after the operation.SPSS 26.0 was used for statistical analysis of the data.RESULTS The patients were followed up for more than 1 year.The CAS scores,visual acuity,intraocular pressure,exophthalmos and quality of life were improved compared with the indicators before,and the differences were statistically significant.However,3 cases with diplopia and 3 cases with strabismus were remaining continuously.CONCLUSION Individualized modified endoscope-assisted deep lateral wall combined with medial wall decompression has a positive effect on the deterioration of visual acuity in patients with active refractory Dysthyroid Optic Neuropathy.