甲状腺相关眼病性眼外肌病变的手术治疗

Surgical management of strabismus associated with thyroid-related myopathy

目的 :探讨甲状腺相关眼病性眼外肌病变的手术治疗特点。方法 :回顾分析我院自 1993年 1月到 1999年 12月施斜视矫正术的 2 0例甲状腺相关眼病性眼外肌病变患者。其中男 14例 ;女 6例 ;年龄 2 8 0～ 67 0岁 (平均 5 0 2岁 )。手术方式包括下直肌后退术 (12条 ) ,上直肌后退术 (7条 ) ,下直肌缩短术 (4条 ) ,上直肌缩短术 (2条 ) ,上直肌断腱术 (2条 ) ,内直肌后退术 (1条 ) ,外直肌缩短术 (1条 )。术后平均随访 1年。结果 :术后 9例达到正位 ,复视消失 ;7例术后斜视度小于或等于 5° ,4例有小度数斜视但复视明显改善 ;手术并发症为 :肌肉缝线撕脱 2例 ,过矫 3例 (肌肉缝线撕脱 ) ,欠矫 4例 ;轻度眼睑退缩 5例。经手术探查肌肉复位后眼位矫正满意。结论 :甲状腺相关眼病性眼外肌病变的手术治疗效果满意。

Objective:To study the characteristics of surgical treatment of thyroid-related myopathy. Methods:20 cases of strabismus derived from thyroid-related myopathy were managed by strabismus surgery.The surgeries included recession of rectus muscles (20 muscles),resection of rectus muscles (7muscles),and myoectomy of superior rectus muscles (2 muscles).The patients were followed up for 1 year averagely.The most optimal time when the surgery should be performed,the choice of procedure and some special attentions in surgery were discussed. Results:Normal ocular alignment was obtained in 9 patients with no diplopia after operation.7 patients had an under correction of equal to or less than 5°,4 patients still had a small deviation but the diplopia status was improved.Surgical complications included the slippage of muscle due to suture laceration (2 cases),over correction (3 cases),under correction (4 cases) and eyelid retraction (5 cases).Two of the three cases of over correction were caused by slipped muscles. Conclusions:The result of surgical treatment of thyroid-related myopathy seems remarkably good.