TAO致限制性斜视患者行直肌后徒联合后部巩膜缝线悬吊固定术的疗效

Effect of rectus recession combined with the rear suspension scleral fixation in patients with restrictive strabism us caused by thyroid associated ophthalmopathy

目的:探讨直肌后徙联合后部巩膜缝线悬吊固定术对甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)限制性斜视患者临床治疗效果的影响。方法:回顾性分析本院2013-01/2015-01收治的48例71眼重度TAO患者的临床资料,分为眼球高度突出(exophthalmos,EM)组25例35眼,压迫性视神经病变(compressive optic neuropathy,CON)组12例20眼及暴露性角膜病变组(exposure keratopathy,EK)11例16眼,患者均接受直肌后徙联合后部巩膜缝线悬吊固定术治疗,记录各组患者术前及术后6mo时视力、临床活动性评分(clinical activity score,CAS)及复视情况。结果:三组患者术后最佳矫正视力显著大于术前,差异有统计学意义(P<0.01)。CON组、EM组及EK组患者术后眼球突出度较术前显著减少,差异有统计学意义(P<0.01),其中CON组眼球回退值大于其余两组(P<0.01)。三组患者术后CAS评分显著低于术前,差异有统计学意义(P<0.01)。三组患者术后复视分级较术前显著下降(P<0.01),其中CON组术后复视级别下降程度大于其余两组(P<0.05)。结论:直肌后徙联合后部巩膜缝线悬吊固定术能有助于恢复TAO限制性斜视患者视力恢复及眼球回退,消除患者复视,有助于改善患者生活质量。

AIM：To investigate the therapeutic effect of rectus recession combined with the rear suspension scleral fixation for patients with restrictive strabismus caused by thyroid associated ophthalmopathy（TAO）.METHODS：The clinical data of 48 patients（71 eyes）with severe TAO were retrospective analyzed from January 2013 to January 2015.The patients with severe TAO were divided into the exophthalmos（EM） group with 25 patients（35 eyes）,compressive optic neuropathy（CON） group with 12 patients（20 eyes） and exposure keratopathy（EK） group with 11 patients（16 eyes）.The rectus recession combined with rear suspension scleral fixation treatment was performed in all patients.The visual acuity,clinical activity score（CAS）,and diplopia situation of each group were recorded and compared preoperatively and at 6mo postoperatively.RESULTS：The postoperative best corrected visual acuity（BCVA） of the three groups were significantly higher than those before operation（P〈 0.01）.The postoperative exophthalmos of CON group,MP group and EK group were significantly more improved than those before operation（P〈 0.01）.The eyeballs of patients in CON group retracted significantly more than the other two groups（P〈 0.01）.The CAS was significantly lower after operations than that before operations（P〈 0.01）.The diplopia in patients in CON group decreased more than the other two groups（P〈 0.05）.CONCLUSION：Rectus recession combined with the rear suspension scleral fixation can help improve the restrictive strabismus caused by TAO,visual acuity,eyeballs to roll back,eliminate the diplopia and to improve the life quality of patients.