内镜下经筛肌锥内脂肪减压矫治Graves眼病性突眼

Endoscopic transethmoid intraconal fat decompression for proptosis reduction in thyroid associated orbitopathy

目的研究一种矫正以脂肪增生为主的Graves眼病(GO)性过度眼球突出的新方法。方法对以脂肪增生为主的GO患者采取内镜下经筛径路眶肌锥内脂肪减压术(ETIFD)治疗。所有GO患者均确诊为处于非炎症活动期的以脂肪增生为主型GO。术后6个月分析眼球突出矫正度以及并发症等,以评价疗效。结果共收集资料齐全者24例44眼。术前眼球突出度(19.98±1.80)mm(17～23)mm,术后6个月眼球突出度为(12.93±0.76)mm(12～14)mm,平均眼球突出矫正度达(7.05±1.40)mm(4～10)mm(P<0.001)。所有患者双眼眼球突出度差值均小于2mm。10例患者术后出现水平复视,其中8例术后1个月内完全消失,2例术后6个月仍存在予以三棱镜矫正。无其他并发症发生。结论 ETIFD为矫治以脂肪增生为主型GO突眼的一种较理想方法。

[Objective] To study the suitability of an endoscopic transethmoid intraconal fat decompression（ETIFD） for proptosis reduction in patients with Graves＇ orbitopathy（GO）.[Methods] Based on the history,complete ophthalmic examinations,and computer tomography or MRI scans of the orbit,all patients were diagnosed in the inactive phase of lipovarant GO and underwent the ETIFD for proptosis reduction from October 2006 to December 2011.The patients were followed up periodically at least for 6 months after surgery.At the 6-month review,outcomes including proptosis reduction,incidence of diplopia and other complications were reviewed and analyzed.[Results] Twenty-four patients（44 orbits） with complete clinic data were analyzed in this study.Preoperative,the exophthalmometer value（EV） of the affected eyes ranged from 17 to 23 mm [mean,（19.98±1.80） mm];At the 6 month review,the EV improved to（12.93±0.76） mm（range,12~14） mm.A postoperative symmetry to within 2 mm of the both eyes was achieved in all patients（100%,24/24）,with a mean improvement of（7.05±1.40） mm（range,4~10） mm（t=33.455,P 0.001）.Ten of 24 patients presented horizontal diplopia within 30 degree visual field of the lateral gaze,in which 8 patients disappeared within one month after surgery.At the 6 month review,except that 2 patients complained diplopia and corrected with triangular lens,no patients presented any complications.[Conclusion] ETIFD is an effective treatment with minimal morbidity for proptosis reduction in lipovarant GO.