手术治疗甲状腺相关眼病限制性斜视

Surgical management on restrictive strabismus of patients with thyroid associated ophthalmopathy

目的评价眼外肌后徙术治疗甲状腺相关眼病限制性斜视的疗效。设计回顾性病例系列。研究对象单眼单条眼外肌受累的静止期甲状腺相关眼病限制性斜视患者15例。方法行受累眼外肌后徙术。手术前后用视野弧测定患者的双眼单视野面积;用直尺测量眼球由原在位向受限制方向转动的距离;用同视机测定9方位斜视度。主要指标手术前后双眼单视野面积、受限制方向眼球运动距离、受限制眼注视时原在位和下转15°绝对斜视度。结果9眼行下直肌后徙术,4眼行上直肌后徙术,2眼行内直肌后徙术。手术治疗前的平均双眼单视野面积为(23.99±19.39)°,手术后为(2115.72±527.10)°。手术治疗前受限制方向眼球运动的平均距离为(1.53±0.97)mm,手术后为(6.03±0.74)mm。手术治疗前受限制眼原在位注视时平均绝对斜视度为(22.37±6.63)°,手术后为(1.53±1.47)°。手术治疗前受限制眼下转15°注视时的平均绝对斜视度为(15.67±11.53)°,手术后为(2.17±1.90)°。手术治疗前后上述各观察指标均有统计学差异。5眼术前存在高眼压,术后降至正常范围。术前所有患者存在代偿头位,术后均消失。术后9眼出现眼睑退缩,未出现严重并发症。结论眼外肌后徙术能够明显消除复视和斜视,改善眼球运动。(眼科,2007,16:414-417)

Objective To evaluate the outcomes of recession of extraocular muscles on restrictive strabismus of patients with thyroid associated ophthalmopathy. Design Retrospective case series. Participants Fifteen thyroid associated ophthalmopathy （TAO） patients with stationary restrictive strabismus caused by myopathy of one extraocular muscle of one eye. Methods Recession of the diseased extraocular muscles was applied. Before and after operation, the areas of binocular vision without diplopia on a acr perimeter measured the movement distances of eyeball from the primary position to the restricted direction, the angles of strabismus in nine directions with synoptophore were measured in all patients. Main Outcome Measures The areas of binocular vision without diplopia, the movement distances of eyeball from the primary position to the restricted direction, and the absolute angles of strabismus in primary position and downward 15°direction when the restricted eye gazed target were compared before and after operation. Results Inferior rectus muscle recession were performed in nine eyes, superior rectus recession were performed in 4 eyes, and medial rectus recession in 2 eyes. The average areas of binocular vision without diplopia significantly increased from 23.99±19.39° before operation to 2115.72±527.10° after operation. The average movement distances of eyeball from the primary position to the restricted direction significantly increased from 1.53±0.97 mm before operation to 6.03±0.74 mm after operation. The average absolute angles of strabismus in primary position gazed by the restricted eyes significantly decreased from 22.37±6.63° before operation to 1.53±1.47°after operation. The average absolute angles of strabismus in downward 15°direction gazed by the restrieted eyes significantly decreased from 15.67±11.53°before operation to 2.17±1.90° after operation, lntraocular hypertention in 5 patients before operation decreased among normal range after operation. Compensatory head posture in all patients before operation disappeared after operation. Eyelid retraction was the main surgical complication. Condusion Recession of extraoeular muscles can markdely eliminate diplopia and strabismus, improve eyeball motability. （Ophthalmol CHN, 2007, 16： 414-417）