聚焦眼眶减压手术治疗甲状腺相关视神经病变的争议问题

Focus on the controversial problems of orbital decompression in the treatment of dysthyroid optic neuropathy

甲状腺相关视神经病变是甲状腺相关眼病引起的压迫性视神经病变，严重威胁视力，目前常用的治疗手段包括糖皮质激素冲击治疗和眼眶减压手术。尽管糖皮质激素冲击治疗被临床推荐为首选治疗方法，尽管眼眶减压手术尚存在颇多争议问题，但是后者仍是临床不可或缺的治疗手段。通过回顾眼眶减压手术的作用机制、治疗结局及其与糖皮质激素冲击治疗比较的利弊，阐明针对甲状腺相关视神经病变，糖皮质激素冲击和眼眶减压手术的联合治疗应是更为恰当的治疗措施。

Dysthyroid optic neuropathy （DON） is the most common cause of visual loss in thyroid associated ophthalmopathy, for which steroid pulse therapy and orbital decompression are the common treatments currently. While steroid pulse therapy was recommended as the first-choice for DON, orbital decompression remained as an indispensable therapy although controversies on such treatment still exist. The mechanism, approaches and outcomes of orbital decompression, as well as its advantages and disadvantages over steroid pulse therapy were retrospectively reviewed, and it was suggested that the combination therapy of steroid pulse therapy and surgical decompression might be the better choice for the treatment of DON. （Chin J Ophthalmol, 2018, 54： 488-490）