眼肌肥厚型甲亢突眼的治疗术式选择及预后研究

Surgical Selection and Prognosis of Hypertrophic Hyperthyroidism in the Eye Muscle

目的:本研究旨在探讨鼻内镜下眼眶减压术对于眼肌肥厚型甲亢突眼的临床治疗效果。方法:本研究回顾性分析了2014年9月-2017年9月在笔者医院眼科接受鼻内镜下眼眶减压术的23例(43眼)眼肌肥厚型甲亢突眼患者的临床资料。所有患者在术前和术后2个月均接受了眼科检查,包括Hertel眼突计、A型超声生物测量仪、自动屈光测量、角膜地形图以及波前像差。结果:术前平均眼球突出度为(19.6±2.4)mm,术后为(15.5±2.1)mm,明显降低,差异有统计学意义(P<0.001)。43眼中,34眼(79.0%)近视,7眼(16.3%)正视和2眼(4.7%)远视。术后,平均眼轴长度(AL)显著增加,球镜屈光度(Dsph)和等效球镜度数(SE)显著降低,差异有统计学意义(P<0.05);模拟角膜屈率(K)有所减少,但差异无统计学意义(P>0.05);前房深度(ACD)、角膜厚度(LT)、柱镜屈光度(Dcyl)、柱镜轴向、角膜表面不规则指数(CIM)、形状因子(D)、总像差和高阶像差手术前后比较,差异无统计学意义(P>0.05)。结论:经鼻内镜眶内、下壁部分切除术治疗眼肌肥厚型甲亢突眼效果显著,是治疗眼肌肥厚型甲亢突眼的有效方法。

Objective The purpose of the present study was to investigate the clinical effects of endoscopic orbital decompression for patients with ocular hypertrophic hyperthyroidism. Methods The present study retrospectively analyzed the clinical data of a total of 23 patients(43 eyes) with ocular hypertrophic hyperthyroidism who underwent endoscopic orbital decompression in our hospital from September 2014 to September 2017. All patients underwent an ophthalmologic examination before and 2 months after surgery, including Hertel orthodontics, type A ultrasound biometrics, automatic refractive measurements, corneal topography, and wavefront aberrations. Results The average degree of exophthalmos before operation was(19.6±2.4)mm, and after operation was(15.5±2.1)mm, the difference was significant(P<0.001). There were 43 eyes,34 eyes(79.0%) myopia, 7 eyes(16.3%) emmetropia and 2 eyes(4.7%) hyperopia. After operation, the average axial length(AL) increased significantly, while the spherical diopter(Dsph) and equivalent spherical diopter(SE) decreased significantly(P<0.05). Postoperative simulated corneal flexion rate(K) decreased, but there was no significant difference(P >0.05).There was no significant difference in anterior chamber depth(ACD), corneal thickness(LT), columnar diopter(Dcyl),columnar axis, corneal surface irregularity index(CIM), shape factor(D), total aberration and higher order aberration before and after surgery(P>0.05). Conclusion Transnasal endoscopic partial orbital and inferior wall resection is an effective method to treat ocular hyperthyroidism exophthalmos with hypertrophic ocular muscles.