摘要
目的探讨甲状腺相关眼病(TAO)眼眶减压术后继发内斜视伴复视的斜视矫正手术治疗效果。方法回顾性系列病例研究。选取2016年3月至2018年10月在天津市眼科医院因TAO行眼眶减压术后继发内斜视伴复视行斜视矫正手术治疗的11例患者资料。斜视矫正手术前、后检查患者斜视度数、眼球运动,观察复视情况。手术均在监护下麻醉联合局部麻醉下进行,术中采用被动牵拉试验结合调整缝线方法,调整至第一眼位复视消失。术后定期随访。结果11例患者中男性1例,女性10例;年龄26~42岁;均为单纯内斜视伴复视;内斜视度数10~98三棱镜度;眼眶CT提示患者内直肌不同程度增厚,外直肌增厚程度较内直肌轻。2例患者行单眼内直肌后徙术,2例行双眼内直肌后徙术,2例行单眼内直肌后徙联合外直肌缩短术,另外5例行双眼内直肌后徙联合单眼外直肌缩短术。11例患者术中内直肌后徙量为3.5~7.5 mm,7例联合外直肌缩短术患者外直肌缩短量为2.0~6.0 mm。全部患者术后复视消除,第一眼位正位,均达到治愈标准。眼球运动术前外转受限分级为(-1.91±1.04)级,术后外转受限分级为(-0.64±0.81)级。11例患者均对手术结果满意,术后随访6~24个月,效果稳定,未发现远期过矫患者。结论应用术中调整缝线技术,斜视矫正手术可以有效治疗TAO眼眶减压术后继发的内斜视伴复视。
Objective To evaluate the effect of extraocular muscle surgery in treating secondary esotropia with diplopia after orbital decompression for thyroid-associated ophthalmopathy(TAO).Methods Retrospective case series study.Eleven secondary esotropic patients with diplopia after orbital decompression for TAO who underwent extraocular muscle surgery during March 2016 and October 2018 in Tianjin Eye Hospital were included.All patients had new onset esotropia after decompression surgery and underwent strabismus surgery.Deviation angle,diplopia,and ocular movement were observed preoperatively and postoperatively.Surgeries were carried out under the monitored anesthesia care combined with local anesthesia,and the eye alignment was adjusted to orthotropia with no diplopia in the operation with the technique of intraoperative adjustable suture and forced duction test results.All the patients were followed up.Results The ages of the patients were from 26 to 42 years(1 male and 10 females).The deviation angles were 10-98 prism diopter.Orbital CT scan showed that the horizontal rectus thickness was increased at different levels,and the thickness of the medial rectus was increased more than that of the lateral rectus.Two patients had monocular medial rectus recession only,2 had bilateral medial rectus recession only,2 had monocular medial rectus recession combined with lateral rectus resection,and the other 5 had bilateral medial rectus recession with monocular lateral rectus resection.The recession of medial rectus muscle was 3.5 to 7.5 mm in 11 patients and 2.0 to 6.0 mm in 7 patients with the resection of lateral rectus muscle.Diplopia of the 11 patients disappeared with orthotropia at primary gaze position after the extraocular muscle surgery.The limitation of abduction changed from preoperative(-1.91±1.04)to postoperative(-0.64±0.81).All the patients were satisfied with the surgical results.At the end of the follow-up(6 to 24 months),the results of the patients were stable,and no over-correction was found.Conclusion Extraocular muscle surgery with intraoperative adjustable suture technique can effectively treat TAO patients with secondary esotropia with diplopia after orbital decompression.(Chin J Ophthalmol,2020,56:183-188)
作者
李燕伟
杨士强
张伟
郭新
Li Yanwei;Yang Shiqiang;Zhang Wei;Guo Xin(Tianjin Eye Hospital,Tianjin Key Lab.of Ophthalmology and Visual Science,Nankai University Affiliated Eye Hospital,Clinical College of Ophthalmology of Tianjin Medical University,Tianjin Eye Institute,Tianjin 300020,China;Department of Ophthalmology,the First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2020年第3期183-188,共6页
Chinese Journal of Ophthalmology
关键词
GRAVES眼病
减压术
外科
内斜视
复视
眼外科手术
Graves ophthalmopathy
Decompression
surgical
Esotropia
Diplopia
Ophthalmologic surgical procedures
