下直肌后退术治疗甲状腺相关眼病性眼外肌病变

Inferior rectus recession in the management of strabismus associated with thyroid-related myopathy

目的探讨下直肌后退术治疗甲状腺相关眼病性眼外肌病变的适应证、手术特点和效果等。方法回顾分析诊治的39例甲状腺相关眼病性眼外肌病变需作下直肌后退术的患者。其中男24例：女15例：年龄28．0—66．0岁（平均49．9岁）。手术方式包括下直肌后退术31例；下直肌断腱术l例：下直肌后退＋上直肌缩短3例；下直肌后退＋内直肌后退2例：右眼下直肌后退＋左眼内直肌后退外直肌缩短1例；左眼下直肌后退＋右眼上直肌后退下直肌缩短1例。术后平均随访1．4年。结果术后25例正位，复视消失；欠矫5—15。10例，复视明显改善：过矫4例。20。以内的下斜视行下直肌后退术每1mm后退平均可矫止2．5°。大度数垂直斜（20°～〉45°），78．9％（15／19）行患眼下直肌后退术可矫正；21．0％（4／19）需行下直肌断腱术或加患眼上直肌缩短术。所有大度数垂直斜均需作眼球缝线固定术。结论下直肌后退术治疗甲状腺相关眼病性眼外肌病变的限制性下斜视效果满意，文中对手术时机、手术特点、手术方式与手术注意点进行了详细的讨论。

Objective To study the indication, surgical management and effect of inferior rectus re- cession on the thyroid-relatod myopathy. Methods Thirty-nine patients of strabismus associated with thy- roid-related myopathy who were managed by inferior rectus recession were retrospectively analyzed. Twen- ty-four patients were male and 15 were female, with their age ranging from 28 to 66 years old （mean, 49.9 years）. The strabismus surgery included recession of inferior rectus muscle （ 31 cases）, myectomy of inferior rectus （ 1 case）, recession of inferior rectus and resection of superior rectus （3 cases）, recession of inferior rectus and medial rectus （2 cases）, recession of inferior rectus of the right eye and recession of medial rectus and resection of lateral rectus of the left eye （ 1 case）, inferior rectus recession of the left eye and recession of superior rectus and resection of inferior rectus of the right eye （ 1 case ）. The patients were followed up for an average of 1.4 year. Results Normal ocular alignment was obtained in 25 patients with no diplopia after oper- ation, 10 patients had an undercorrection of 5-15° and their diplopia was improved a lot, 4 patients had surgi- cal overcorrection of strabismus. Less than 20° vertical strabismus could be corrected by inferior rectus reces- sion with 2.5° correction by each lmm recession. 78.9% （ 15/19 ） of large vertical strabismus could be correct- ed well by inferior rectus recession of the affected eye. 21.0% of them need myectomy of inferior rectus or re- cession of inferior rectus plus resection of superior rectus. The management of all large vertical deviation needs a suture fixation of eyeball. Conclusions The therapeutic effect of recession of inferior rectus on patients with thyroid-related myopathy was remarkably good in our hands. The most optimal time when surgery should be performed, the choice of procedure and some special attention in performing surgery were discussed in detail.