非开眶小切口内外壁均衡减压术治疗甲状腺相关眼病的临床观察

Clinical effects of balanced decompression of the inner and outer walls through non-orbital small incisions in the treatment of thyroid related ophthalmopathy

目的探讨非开眶小切口内外壁均衡减压术治疗甲状腺相关眼病(TAO)的临床效果。方法收集2021年1月至2023年1月于解放军总医院第三医学中心眼科医学部眼眶病外科确诊为TAO并行非开眶小切口内外壁均衡减压术的患者25例(40只眼)进行研究。其中,男性8例(10只眼),女性17例(30只眼)。年龄21~42岁,平均年龄(36.4±6.1)岁。全部患者行非开眶小切口内外壁均衡减压术治疗;其中,眼球运动受限合并限制性斜视者于眼眶减压手术中同时行斜视矫正术。询问并记录所有患者的性别和年龄;检查并记录患者术前和术后3个月的最佳矫正视力(BCVA)、眼球突出度、眼压、眼球运动及复视情况。性别、年龄、眼球运动情况及复视情况使用频数和百分比进行描述;手术前后的BCVA采用中位数和四分间距表示;眼球突出度和眼压经检验符合正态分布以±s表示。患者手术前后的BCVA的比较采用Wilcoxon符号秩和检验,手术前后患眼的眼球突出度和眼压的比较采用配对t检验。结果全部患者25例(40只眼)中,术前患者的BCVA中位数为0.8(0.6,1.0),术后BCVA中位数为0.8(0.6,1.0),其差异无统计学意义(Z=5.84,P>0.05)。其中,有2例(2只眼)术前BCVA均为0.6,术后BCVA分别提高至0.8和1.0。术前整体患者的眼球突出度为20~24 mm,平均眼球突出度(21.35±1.15)mm,术后3个月眼球突出度为14~19 mm,平均眼球突出度(16.95±1.47)mm,较术前眼球突出度降低(4.4±1.03)mm,其差异具有统计学意义(t=4.454,P<0.05)。术前整体患者眼压(20.8±3.26)mmHg(1 mmHg=0.133 kPa),术后3个月眼压(16.95±2.08)mmHg,眼压较术前降低(3.85±2.21)mmHg,其差异具有统计学意义(t=5.314,P<0.05)。术前,眼球运动受限但无限制性斜视者8例(10只眼),均有复视症状;术后眼球活动均有不同程度的改善,复视症状减轻。术前眼球运动受限合并限制性斜视者6例(6只眼),术后眼正位无明显复视者5例(5只眼);1例(1只眼)患者术后有间歇性外斜视15°,仍有轻度复视症状,但不影响日常生活和阅读。结论非开眶小切口内外均衡减压术疗效确切,皮肤切口小而隐秘,无需开眶,适用于美容需求高、眼球突出度低且无严重视神经压迫病变的患者。

Objective To investigate the clinical effect of balanced orbital decompression without marginotomy on thyroid-associated ophthalmopathy(TAO).Methods A total of 25 patients(40 eyes)diagnosed with TAO in the Department of Ophthalmology of the Third Medical Center of the People′s Liberation Army General Hospital and underwent balanced orbital decompression without marginotomy from January 2021 to January 2023 were collected.Among them,8 cases(10 eyes)were malesand 17 cases(30 eyes)were females with an average age of(36.4±6.14)years(ranged from 21 to 42 years).All patients underwent balanced orbital decompression without marginotomy.For patients with limited eye movement and restrictive strabismus,they underwent strabismus correction surgery simultaneously during orbital decompression surgery.The gender,age,best corrected visual acuity(BCVA),proptosis,intraocular pressure,eye movement,and diplopia of all patients were examined and recorded before and after surgery for 3 months.The gender,age and eye movement was described by frequency and percentage.The BCVA of patients were expressed as median and interquartile before and after surgery and compared by the Wilcoxon signed rank test.The patient′s proptosis and intraocular pressure conformed to normal distribution,and were described by±s and compared by paired t-test before and after surgery.Results Among 25 patients(40 eyes),the median and interquartile of BCVA was 0.8(0.6,1.0),0.8(0.6,1.0)before and after surgery,respectively.There was a significant difference between them(Z=5.84,P>0.05).Among them,the BCVA of 2 cases(2 eyes)before surgery were both 0.6,which reached 0.8 and 1.0 respectively after surgery.The overall proptosis was 20 to 24 mm and the average proptation was(21.35±1.15)mm before surgery.After surgery for 3 months,the proptosis was 14 to 19 mm,and the average proptation was(16.95±1.47)mm,which significantly reduced by(4.4±1.03)mm than that before surgery(t=4.454,P<0.05).The overall intraocular pressure was(20.8±3.26)mmHg(1 mmHg=0.133 kPa)and(16.95±2.08)mmHg before and after surgery,respectively,which significantly reduced by(3.85±2.21)mmHg than that before surgery(t=5.314,P<0.05).Eight cases(10 eyes)with restricted eye movement without restricted strabismus before surgery had symptoms of diplopia,and their ocular activities had been improved to various degrees after surgery,and the symptoms of diplopia were reduced.There were 6 cases(6 eyes)with restricted eye movement restriction and restrictive strabismus before surgery.After surgery,5 cases(5 eyes)with normal eye position had no obvious diplopia,and 1 case(1 eye)had intermittent exotropia 15°combined with mild diplopia symptoms after surgery,while did not affect daily activities and reading.Conclusions The clinical effects of balanced orbital decompression without marginotomy is obvious,which has a small and invisible skin incision without marginotomy and is suitable for patients with high cosmetic demands,low proptosis and without serious compressive optic neuropathy.