甲状腺相关眼病所致限制性斜视的手术治疗

The surgical management of restrictive strabismus caused by thyroid-associated ophthalmopathy

目的探讨甲状腺相关眼病（TAO）所致限制性斜视的临床特点及直肌断腱术的治疗效果。方法对37例静止期TAO限制性斜视通过单眼遮盖，眼球运动检查及被动牵引试验，检出受限最大的眼外肌。对限制最明显的1条或多条眼外肌实行断腱后退术或加拮抗肌缩短术。术前、术后检查眼位、眼球运动、复视等情况。结果所有患者术后症状明显改善，37例中治愈32例（86．5％），术后复视消失，眼球运动受限明显改善，术后斜视度≤5°；好转4例（10．8％）；欠矫1例（2．7％）。并发症有下睑退缩4例。结论直肌断腱是治疗TAO限制性斜视的可靠手术方法，效果良好。

Objective To investigate the clinical features of restrictive strabismus caused by thyroid-associated ophthalmopathy （TAO） and the effect of rectus tenotomy for restrictive strabismus. Methods Thirty-seven TAO patients with restrictive strabismus were collected in our hospital. For every patient, the most restricted extraocular muscles were determined by monocular cover, eye movement and passive traction test. Rectus tenotomy only or combined with shortening the antagonist mucle was performed on the most restricted one or more muscles. The position of eyes, eyes movements and diplopia were measured pre- and post-operatively. Results All the patients had good results. Thirty-two patients （86.5%） had the elimination of diplopia, significant improvement of eye movements in every direction and the strabismus angle less then 5°. Four cases had obvious improvements and one ease was undereorrection. Four patients had postoperative complicated eyelid retraction. Conclusion Rectus tenotomy can effectively eliminate restrictive strabismus caused by TAO.