眼眶减压术对甲状腺相关眼病患者脉络膜厚度的影响

Effect of orbital decompression on choroidal thickness in patients with thyroid associated ophthalmopathy

目的:探究眼眶减压术对甲状腺相关眼病(TAO)患者黄斑区中心凹脉络膜厚度(CMCT)的影响。方法:前瞻性临床研究。分析2021-01/2022-01在我科治疗的TAO患者29例42眼,根据病情严重程度分为中重度组20例30眼和极重度组9例12眼。两组患者均接受眼眶减压术治疗,比较两组患者术前,术后3、6mo CMCT、最佳矫正视力、眼压、眼球突出度、活动度评分(CAS)的变化情况。结果:所有患者均完成随访。术后3、6mo,极重度组CMCT、眼球突出度、眼压、CAS评分为355.13±15.59、339.61±13.17μm, 19.33±2.23、17.83±1.70mm, 18.86±3.05、18.09±1.37mmHg, 3.75±0.87、2.42±1.00分;中重度组为325.00±10.48、321.04±11.34μm, 16.07±1.74、15.6±1.98mm, 16.65±2.04、16.03±2.3mmHg, 1.50±0.51、1.43±0.50分,与术前(极重度组:396.46±17.61μm, 22.00±2.3mm, 21.85±2.82mmHg, 5.33±1.44分;中重度组:335.77±11.60μm, 19.07±1.84mm, 18.89±3.06mmHg, 1.63±0.49分)比较均有差异(均P<0.001)。极重度组患者术前最佳矫正视力(LogMAR)为0.64±0.22,术后3、6mo分别为0.43±0.20、0.34±0.15,与术前比较均有差异(均P<0.001)。结论:眼眶减压术能有效降低TAO患者CMCT、眼压及眼球突出度,缓解眼眶静脉瘀滞,并能有效改善极重度患者的视力、降低活动性。

AIM:To investigate the effect of orbital decompression on the central macular choroidal thickness(CMCT)in patients with thyroid-associated ophthalmopathy(TAO).METHOD:Prospective clinical studies.A total of 29 TAO patients(42 eyes)treated in our department from January 2021 to January 2022 were analyzed,and they were divided into 20 cases(30 eyes)in the moderate and severe group and 9 cases(12 eyes)in the extremely severe group.Both groups of patients received orbital decompression,and the changes of CMCT,visual acuity,intraocular pressure,exophthalmos,and clinical activity score(CAS)at 3 and 6mo before and after surgery were compared between the two groups.RESULTS:All patients completed follow-up.The CMCT,exophthalmos,intraocular pressure,and CAS of the extremely severe group at 3 and 6mo were 355.13±15.59 and 339.61±13.17μm,19.33±2.23 and 17.83±1.70mm,18.86±3.05 and 18.09±1.37mmHg,3.75±0.87 and 2.42±1.00 points,respectively.The moderate and severe group was 325.00±10.48 and 321.04±11.34μm,16.07±1.74 and 15.6±1.98mm,16.65±2.04 and 16.03±2.3mmHg,1.50±0.51 and 1.43±0.50 points,and there was differences with those before operation(extremely severe group:396.46±17.61μm,22.00±2.3mm,21.85±2.82mmHg,5.33±1.44 points;moderate and severe group:335.77±11.60μm,19.07±1.84mm,18.89±3.06mmHg,1.63±0.49 points;all P<0.001).The best corrected visual acuity(LogMAR)before surgery was 0.64±0.22 in the extremely severe group,and 0.43±0.20 and 0.34±0.15 at 3 and 6mo after operation,respectively,which were different from those before surgery(all P<0.001)CONCLUSION:Orbital decompression can effectively reduce CMCT,intraocular pressure and exophthalmos in TAO patients,relieve orbital vein stasis,and effectively improve vision and reduce mobility in patients with extremely severe disease.