内窥镜眶减压术治疗甲状腺功能障碍性视神经病变

Endoscopic intranasal orbital decompression for dysthyroid optic neuropathy

目的评价内窥镜眶减压术治疗甲状腺功能障碍性视神经病变的临床效果。方法回顾性研究2012年2月到2015年11月确诊为甲状腺功能障碍性视神经病变26例（45只眼），均行内窥镜经鼻眶减压术，观察手术前后视力、眼压、眼球突出度、眼球运动、复视检查、色觉及视野等检查结果。结果内窥镜经鼻眶减压术后，全组45只眼（100％）最佳矫正视力均有提高，无视力下降者。术前最佳矫正视力为光感-0．4者42只眼（93．33％），术后最佳矫正视力为0．5～1．5者41只眼（91．11％）。眼球突出度及眼压均较术前明显降低，6例（23．08％）出现内斜或原有内斜角度增大。无术中术后并发症发生。结论内窥镜经鼻眶减压术安全、有效、微创，无头面部瘢痕，是甲状腺功能障碍性视神经病变良好的手术方法。

Objective To evaluate the therapeutic efficacy of endoscopic transnasal orbital decompression for dysthyroid optic neuropathy（DON）. Methods The data of 45 eyes of 26 cases with DON underwent the endoscopic transnasal orbital decompression surgery between Feb. 2012 and Nov. 2015 were collected and analyzed retrospectively. The visual acuity, intraocular pressure, proptosis, diplopia, colour sense, visual field and eye movement before and after surgery were observed. The follow-up time was 12-24 months. Results The postoperative best corrected visual acuity was improved in 45 eyes（ 100.00% ）. The preoperative best corrected visual acuity was light sense to 0.4 in 42 eyes（93.33% ）. The postoperative best corrected visual acuity was 0.5-1.5 in 41 eyes （91.11%） . The difference in reduction of proptosis and intraocular pressure were statistically significant. New-onset diplopia or its aggravation was recorded in 6 cases （23.08%）. No complication happened during the surgery. Conclusion Endoscopic transnasal orbital decompression is a safe and minimally invasive surgery for the treatment of DON without serious complications.