甲状腺相关眼病限制性斜视手术并发症的临床分析

Clinical analysis of complications after muscle surgery in restricted strabismus caused by thyroid associated ophthalmopathy

目的:总结甲状腺相关眼病(thyroid associate dophthalmopathy,TAO)导致的限制性斜视手术并发症的常见原因及应对策略。方法:回顾性分析于2009-01/2012-02在我院就诊的21例眼外肌手术出现并发症的TAO限制性斜视病例,分析手术前病情、手术情况、手术并发症等临床资料。结果:患者21例中术前有6例为限制性上斜视,15例为限制性下斜视。手术中行上直肌断腱1例,后退5例,下直肌后退15例。术中发生巩膜损伤2例,其中1例在断肌止点时损伤巩膜,1例在将肌肉固定于巩膜上时缝穿巩膜;术中预置缝线滑脱3例;术后早期(术后1mo内)发生欠矫6例,过矫5例;术后晚期(术后6mo后)出现过矫15例,包括6例限制性上斜视患者、9例限制性下斜视;下睑退缩8例。结论:TAO限制性斜视手术矫正容易出现过矫,手术中应严格控制肌肉后退量,下直肌后退时应注意下睑退缩发生的可能。

AIM： To summarize common causes and coping strategy for complications after muscle surgery in restricted strabismus caused by thyroid associated ophthalmopathy （TAO）. METHODS： It was retrospective study. Totally 21 cases after muscle surgery in restricted strabismus caused by TAO, hospitalized from January 2009 to February 2012, were analyzed, including patient＇s condition, extraocular muscle surgery, complications of surgery. RESULTS： Totally 6 cases with hypertropia and 15 cases with hypotropia before operation were observed. The strabismus surgery included myectomy of superior rectus （1 case）, recession of superior rectus （5 cases）, and recession of inferior rectus muscle （15 cases）. Two cases were found injury of sclera, 1 case while cutting off muscle stop and another while suturing and 3 cases were found preset stitches slipped during operation. Undercorrection happened in 6 cases and overcorrection in 5 cases in the early stage after operation （within a month）. Overcorrection was in 15 cases （6 cases with restricted hypertropia and 9 cases with restricted hypotropia） and lower eyelid retreat in 8 cases in the late postoperative period （6 months after operation）. CONCLUSION= Overcorrection tends to occur after muscle surgery in restricted strabismus caused by TAO. Quantity of recession of muscle should be strictly controlled during the surgery. Lower eyelid retreat may occur in recession of inferior rectus muscle.