传统三壁开眶减压术治疗严重甲状腺相关眼病

Traditional three orbital wall decompression for severe thyroid-associated ophthalmopathy

目的观察传统三壁开眶减压术治疗严重甲状腺相关眼病的临床疗效及安全性。方法我院住院诊治的严重甲状腺相关性眼病6例（9眼）中男5例（7眼）女1例（2眼），眼球突出度〉25mm，眶压≥T＋3，伴有暴露性角膜溃疡，视神经压迫视力急剧下降，行传统三壁开眶减压术。对手术前、手术后1周及3个月的视力、眼压、眶压、眼球突出度、VEP、眼球运动度、眼底情况、眼外观情况及CT结果等临床指标进行观察对比，对并发症进行分析。评价传统三壁开眶减压术治疗严重甲状腺相关眼病的有效性及安全性。结果手术后6眼视力提高，3眼保持不变；7眼眼压降低，下降范围1—26mmHg（1mmHg=0．133kPa），2眼眼压不变；眼球突出后退4—9mm，平均（6．17±2．03）mm；所有患者眶压都降低，角膜溃疡好转，睑裂闭合不全者术后闭合明显改善，眼球运动度好转，眼底无改变，外观满意，术后cT显示眼眶减压良好。结论通过各项临床指标的分析显示传统三壁开眶减压术是临床用于治疗严重甲状腺相关眼病的手术方法，没有与该手术方法相关的严重的并发症的发生，它能有效扩大眼眶容积，缓解眼球突出，改善外观，明显降低眶压，是治疗严重甲状腺相关眼病的一种有效安全的手术方式，特别是对威胁视力的甲状腺眼病效果更为显著。

Objective To observe the clinical efficacy and safety of traditional three orbital wall decompression for patients with severe thyroid-associated ophthalmopathy. Methods Nine eyes of 6 patients with severe thyroid associated ophthalmopathy were collected. Whose exophthalmos were over 25 mm or orbital pressure were more than T ± 3, with exposed corneal ulcer and sharp decline of vision caused by optic nerve compression. They were treated with traditional three orbital wall decompression. The changes of vision, intraocular pressure, orbital pressure, degree of exophthalmos and proptosis, restrictions in eye movement, VEP, fundus clinical general appearance, CT results, diplopia, and complications were observed and compared before surgery, one week and three months after surgery. The clinical efficacy and safety of traditional three orbital wall decompression surgery for severe thyroid associated ophthalmopathy were evaluated. Results After the operation, the visual acuity was improved in six eyes, and remained unchanged in 3 eyes. The intraocular pressure decreased by 1-26 mmHg （ 1 mmHg =0. 133 kPa） in seven eyes, and remained unchanged in 2 eyes. The recession of exophthalmos ranged from 4 mm to 9 mm, average （6.17 ±2.03）ram. The pressure within the orbit was reduced signiGcantly in all cases. Corneal ulcers became better and the lagophthalmopathy was improved significantly. Post-operative general appearance was satisfactory in all subjects. Postoperative CT images showed good results of orbital pressure decompression. Conclusion For severe thyroid-associated ophthalmopathy, traditional three orbital wall decompression is effective and safe, as shown by our analysis using clinical indicators. It is safe and effectivein the expansion of orbital volume validitiy, reduction in proptosis, improvement in appearance, and lowering orbital pressure. No serious complications were found.