改良三壁眶减压术治疗重症甲状腺相关性眼病的疗效观察

目的观察改良三壁眶减压术治疗重症甲状腺相关性眼病的效果。方法对我院收治的3例(6眼)经内科治疗无效的重症甲状腺相关性眼病患者实施改良三壁眶减压术,观察患者术后视力、眼球突出度及外观情况。结果术后4眼视力轻度提高,2眼保持不变;眼球后退5.3～12.6mm,平均9.5mm;睑裂闭合不全者术后均闭合良好,外观满意;1眼出现少量眶内血肿,治疗后吸收;4眼出现双眼复视,均于1个月内消失;术后CT显示眼眶减压良好。结论改良三壁眶减压术可有效扩大眼眶容积,降低眶内压,还纳眼球,减少眼球突出,改善外观,对内科保守治疗、常规眶减压术无效的重症甲状腺相关性眼病患者安全有效。     

眼眶减压术20眼临床分析

目的：探讨眼眶减压术对经保守治疗无效的甲状腺相关性眼病的临床疗效与合并症。方法：对12例20眼的术前临床表现、术后的疗效与并发症进行随访并统计。结果：三壁减压使眼球后退6－8mm,外下壁减压后退4－6mm,内下壁减压后退3－5mm。14／16眼（87．5％）角膜损害痊愈,2／16眼（12．5％）好转。17／20眼（85％）视力提高,3／20眼（15％）无改善。并发症包括2眼复视,5眼眶下神经损害,1眼眶继发出血。结论：眼眶减压术对保守治疗无效的甲状腺相关眼病是一种有效、安全、并发症少的治疗手段。可用于继发角膜损害,压迫视神经与要求美容 的病例。     

眼眶减压术治疗甲状腺相关性眼病的研究进展

甲状腺相关性眼病是一种与甲状腺关系密切、以眼球突出等眼部症状为临床表现的自身免疫性疾病.眼眶减压术是其外科治疗的重要方法之一,根据该病的分级及活动程度,可通过外部入路、微创入路、内窥镜入路或联合入路进行眶骨壁减压或眶脂肪减压,随着科学技术的进步及眼科医生不断的经验积累,手术方法不断得到改进,且更科学,疗效更满意.本文对眼眶减压术的各种方法及手术入路的研究进展进行总结,为手术方式的恰当选择提供参考.     

眼眶减压术治疗甲状腺相关性眼病的研究进展

甲状腺相关性眼病是一种与甲状腺关系密切、以眼球突出等眼部症状为临床表现的自身免疫性疾病.眼眶减压术是其外科治疗的重要方法之一,根据该病的分级及活动程度,可通过外部入路、微创入路、内窥镜入路或联合入路进行眶骨壁减压或眶脂肪减压,随着科学技术的进步及眼科医生不断的经验积累,手术方法不断得到改进,且更科学,疗效更满意.本文对...     

眼眶二壁减压术治疗12例Graves眼病 压迫性视神经病变

目的评价眼眶减压术治疗压迫性视神经病变的疗效。方法对12例患者14只Graves眼病合并压迫性视神经病变眼施行了二壁眶减压术,减压骨壁尽量靠近眶尖。结果14只眼术后均能完全闭合。视力提高11只眼,基本不变2只眼,下降1只眼。眼球突度平均减少4.0 mm。结论二壁眶减压术是治疗Graves眼病压迫性视神经病变的有效方法。(中华眼底病杂志,2001,17:303-304)     

甲状腺相关性眼病内镜微创减压术的历史与展望

甲状腺相关性眼病是成人最常见的眼眶疾病,眶减压手术是其重要的治疗手段。随着内窥镜技术的发展,内窥镜下眶减压手术逐渐成为其首选的手术方案。现将重点介绍内窥镜技术在眼眶内侧壁、外侧壁以及下壁减压中的应用进展,并介绍其手术效果以及并发症的预防与处理。同时介绍内窥镜下经筛径路眶减压手术在甲状腺相关性眼病视神经病变中的手术进展。     

眼眶脂肪减压术治疗甲状腺眼病的临床研究

目的 评价眼眶脂肪减压术治疗甲状腺相关眼病的疗效.方法 对10例(12只眼)、经眼睑皮肤和(或)结膜切口入路,切除肌肉圆锥内外的眼眶脂肪,1只眼经下睑睫毛下皮肤切口,在切除肌锥内,外脂肪后用高速磨头磨削眼眶下壁骨壁.结果 切除脂肪量1.9～3 ml,平均2.6ml.术后矫正眼球突出度2～3 mm,平均2.4mm.脂肪减压术联合眼眶骨壁磨削的患者出现了术眼眼球向下移位和向下注视时顽固性复视.其余患者未出现并发症.结论 眼眶脂肪减压术可以减轻眼球突出,是一项安全有效的手术方法,但减压效果有限.     

改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的临床效果

目的　评价改良结膜入路眼眶内下壁减压术治疗轻中度甲状腺相关眼病的疗效。方法　回顾性分析2017年1月至2018年8月在云南省第二人民医院行改良结膜入路眼眶内下壁减压术治疗的10例（11眼）轻中度甲状腺相关眼病患者。所有患者在术前均给予眼眶水平位、冠状位和矢状位CT检查，测量视力、眼球突出度、复视情况，检查眼外观进行眼前段照相等。将手术前、后眼球突出度，视力以及复视的改善情况作为效果评价指标，对相关数据进行统计和分析。结果　本组11眼术前眼球突出度为（18.94±1.40）mm，术后（15.22±1.46）mm；术后与术前比较，眼球突出度降低（3.72±0.64）mm，差异有统计学意义（t=18.379，P＜0.001）。术前视力为 0.53±0.29，术后为0.62±0.32；术后与术前比较，视力提高0.08±0.10，差异有统计学意义（t=-2.733，P=0.021）。术前复视2例；术后新发生复视2例，均为轻度复视。术前已存在复视的患者，术后复视程度无加重。结论　改良结膜入路眼眶内下壁减压术能有效改善甲状腺相关眼病患者的眼球突出度与视力，术后复视发生概率低，手术切口隐蔽美观，是一种可靠且有效的眶减压术式。     

眼眶平衡减压术治疗甲状腺相关眼病

目的 探讨平衡眼眶减压术治疗甲状腺相关眼病的疗效和手术方法。方法 采用内外壁眼眶减压术治疗20例35眼甲状腺相关眼病患者。术后随访平均14个月。观察术后视力、眼球突出度和眼球运动等情况。结果 20例35眼中除1例行眶外壁减压外，其余均行内外壁平衡眼眶减压术。眼球突出度缓解3～11mm，其中3～4mm者5眼，5～9mm者28眼，10～11mm者2眼，平均6．32mm。视力从术前数指提高至0．1者6眼，提高2行以上者8眼，无变化21眼。术后眼球运动明显好转者9眼，运动障碍加重2眼。无视力丧失及术后感染。结论 平衡眼眶减压术是治疗甲状腺相关眼病的有效方法。     

经鼻内镜下眼眶减压术治疗中重度甲状腺相关眼病疗效观察

目的 探讨经鼻内镜下眼眶减压术治疗中重度甲状腺相关眼病的治疗效果。方法 选取我院在2015年6月至2021年5月期间收治的60例中重度甲状腺相关眼病患者为研究对象,所有患者均行经鼻内镜下眼眶减压术,对比患者治疗前和治疗3个月后的最佳矫正视力、眼内压、睑裂高度和眼球突出度。结果 60例87眼中有50只眼(57.5%)术后最佳矫正视力提高,术前术后对比有显著性差异(U=319.7,P=0.04),其余较为稳定,无术后视力持续下降者,术后3月眼球突出度、眼内压和睑裂高度的改善均有显著性差异(t=16.56,P=0.00;t=38.12,P=0.00;t=12.67,P=0.00)。结论 经鼻内镜下眼眶减压术治疗重度甲状腺相关眼病可有效改善患者视力,降低眼内压,利于眼球回退,改善眼部症状。     

Orbital Compartment Syndrome: The Ophthalmic Surgical Emergency

Orbital compartment syndrome is an uncommon, ophthalmic surgical emergency characterized by an acute rise in orbital pressure. When intraorbital tension rises, damage to ocular and other intraorbital structures, including irreversible blindness, may occur if not promptly treated. The diagnosis of orbital compartment syndrome is completely clinical and early recognition and emergent orbital decompression (even prior to imaging) is essential in preventing permanent vision loss. Lateral canthotomy and inferior cantholysis remain the mainstays of management. More extensive incision of the orbital septum and orbital bony decompression may be necessary in unresponsive cases. This review discusses the various etiologies and mechanisms resulting in orbital compartment syndrome, clinical features, imaging findings, treatment, and prognosis.     

Retrobulbar pressures measured during surgical decompression of the orbit.

AIMS/BACKGROUND: In Graves' ophthalmopathy the increase in volume of intraocular muscles and fat will cause elevated intraorbital pressure. In order to investigate the pressure levels involved, intraorbital pressure, or retrobulbar pressure (RBP) was measured continuously in orbits of patients with Graves' ophthalmopathy during surgical decompression. METHODS: Retrobulbar pressure was measured before and during surgical decompression using an intraorbitally applied pressure transducer. RESULTS: In eight patients with dysthyroid optic neuropathy (DON) RBPs between 17 and 40 mm Hg were recorded. At the end of the surgical procedure the mean RBP was reduced from 28.7 mm Hg to 18.7 mm Hg, the decrease ranging from 8 to 12 mm Hg, which showed a high correlation with the starting pressures (p < 0.001). In two cases without DON, pressures were 11 and 9 mm Hg. Forces exerted by spatula manipulation usually resulted in a RBP level of more than 70 mm Hg. CONCLUSIONS: This study shows that RBPs are markedly elevated in Graves' ophthalmopathy and that surgical decompression can result in a significant reduction in the intraorbital pressure. Optic nerve dysfunction in Graves' ophthalmopathy may not be caused exclusively by the direct pressure of swollen extraocular muscles upon the optic nerve, but also by a raised RBP. It is hypothesised that the damage inflicted upon the optic nerve can be caused in consequence by RBP induced incarceration of the nerve, compressed by surrounding periosteal lined orbital fat bulging posteriorly into the entrance of the optic canal.     

Orbital decompression: current concepts

The orbit in Graves disease undergoes expansion in soft tissue content as a result of the infiltration of orbital fat, extraocular muscles, and the lacrimal gland. Compression of the intraorbital contents leads to disorders of the lid-corneal interface, keratopathy, motility disturbances, exophthalmos, and optic neuropathy. Orbital decompression has traditionally been reserved for those patients with unremitting optic neuropathy. This article provides a historical review of orbital decompression, as well as a review of the evolution of surgical approaches toward both soft tissue and bony decompression. Recent trends in surgical management include fat decompression, more extensive posterior sculpting of the lateral wall, and direct approaches to the medial wall. Preoperative predictors of diplopia and hypoglobus are addressed, as are the various techniques that are employed to limit new postoperative strabismus. The roles of endoscopy and combined surgical techniques are also reviewed. Expanded indications for decompression and its effect on increased intraocular pressure are discussed as well.     

Orbital decompression surgery for the treatment of Graves' ophthalmopathy: comparison of different techniques and long-term results

AIM: To evaluate the long-term results of different orbital decompression techniques performed in patients with Graves'' ophthalmopathy (GO). METHODS: Totally 170 cases with GO underwent orbital decompression between 1994 and 2014. Patients were divided into 4 groups as medial-inferior, medial-lateral (balanced), medial-lateral-inferior, and lateral only according to the applied surgical technique. Surgical indications, regression degrees on Hertel exophthalmometer, new-onset diplopia in the primary gaze and new-onset gaze-evoked diplopia after surgery and visual acuity in cases with dysthyroid optic neuropathy (DON) were compared between different surgical techniques. RESULTS: The study included 248 eyes of 149 patients. The mean age for surgery was 42.3±13.2y. DON was the surgical indication in 36.6% of cases, and three-wall decompression was the most preferred technique in these cases. All types of surgery significantly decrease the Hertel values (P<0.005). Balanced medial-lateral, and only lateral wall decompression caused the lowest rate of postoperative new-onset diplopia in primary gaze. The improvement of visual acuity in patients with DON did not significantly differ between the groups (P=0.181). CONCLUSION: The study show that orbital decompression surgery has safe and effective long term results for functional and cosmetic rehabilitation of GO. It significantly reduces Hertel measurements in disfiguring proptosis and improves visual functions especially in DON cases.     

深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病

目的：探究深外侧壁联合内侧壁眼眶减压术治疗甲状腺相关性眼病的临床治疗效果及安全性。

方法：分析我科既往住院患者病历,纳入2019-01/2020-05在我科住院的符合纳入标准的甲状腺相关性眼病患者17例。所有患者均在全身麻醉下行深外侧壁联合内侧壁眼眶减压术,比较患者术前术后的视力、暴露性角膜炎恢复情况、突眼度、眼压以及并发症情况。

结果：所纳入研究的对象中,有甲状腺相关眼病视神经病变(DON)8例9眼,术前的最佳矫正视力0.78±0.15,术后1mo 0.36±0.12,与术前视力相比有差异(P<0.01),术后6mo 0.38±0.12,与术后1mo无差异(P=0.594)。术前眼球突出度23.75±2.55mm,术后1mo为14.85±1.53mm,与术前突眼度相比有差异(P<0.01),术后6mo为14.60±1.64mm,与术后1mo基本保持稳定(P=0.658)。术前眼压25.56±3.23mmHg,术后1mo为18.42±2.35mmHg,与术前相比有差异(P<0.01),术后6mo眼压降至15.82±2.57mmHg,与术后1mo眼压相比有差异(P<0.01)。术前有暴露性角膜炎6例6眼,术后1mo有4眼好转,2眼治愈,术后6mo 6眼全部治愈。术后患者复视情况均有不同程度减轻,并有部分患者复视症状在此后6mo持续好转,未出现其他严重并发症。

结论：深外侧壁联合内侧壁眼眶减压术可以有效地改善眼突,对DON及暴露性角膜炎等严重并发症也有良好的疗效,并发症少,是治疗严重甲状腺相关性眼病的有效手术方案。     

Recurrent vision loss after endoscopic sinus surgery managed with palmar pressure

A 41-year-old woman underwent endoscopic sinus surgery and 24 hours later, she developed acute orbital emphysema with marked vision loss. CT showed disruption of the inferior aspect of the medial wall of the orbit with fat herniation. She was immediately treated with the application of bedside palmar pressure to the globe with complete return of her vision without the need for a needle aspiration or orbital decompression. Weeks later, the patient experienced 2 more episodes of transient monocular visual loss that were again successfully treated with the same palmar pressure. Bedside digital decompression may be a potentially helpful method of restoring vision in cases of orbital emphysema with acute vision loss. We advise attempting this simple bedside procedure before committing the patient to a more invasive needle aspiration or surgical decompressive procedure.     

Results of diplopia and strabismus in patients with severe thyroid ophthalmopathy after orbital decompression

Purpose:

It has been frequently stated that the orbital decompression, in patients with thyroid ophthalmopathy, does not usually improve extraocular muscles function and that after the operation there is often a deterioration of these functions. The purpose of this article is evaluation of extraocular muscles function after applying personal method of 3 wall orbital decompression.

Materials And Methods:

Retrospective review of case records of 119 patients with severe thyroid ophthalmopathy seen and treated by the author between December 1986 and December 2010. All patents underwent 3 wall orbital decompression combined with removal of the periorbital, intraorbital and retrobulbar fat. Correction of coexistent eyelid retraction and deformities were also performed.

Results:

Comparison of preoperative and postoperative results was conducted in 65 patients three months after 3 wall decompression. All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average], reduction of intraocular pressure, marked improvement in ocular muscle function as well as considerable reduction in or disappearance of subjective symptoms. There were no cases of subsequent impairment of ocular motility. Strabismus surgery was performed in 6 patients with residual diplopia. There was an improvement in vision in 68% patients who had impaired vision before the operation. Less evident relapse of exophthalmos was recorded in 3 cases only and only one patient required unilateral reoperation.

Conclusion:

It can be concluded that this method of orbital decompression is logical, based on an understanding of the pathology, has less complication rates, is relatively easy to perform, gives very good functional and aesthetic long term results and allows rapid recovery.     

Clinical profile and visual outcomes after treatment in patients with dysthyroid optic neuropathy

Purpose

To report the clinical data and visual outcomes after treatment of patients with dysthyroid optic neuropathy (DON).

Methods

We retrospectively reviewed the medical records and orbital images of 40 patients (65 eyes) with DON and analyzed the visual outcomes after treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression.

Results

The study included 21 men and 19 women, with 10 (25%) being diabetic patients. Visual field test results revealed defects in 88.7% of DON eyes; afferent pupillary defects in 63.2%; reduced color vision in 78.5%; and abnormal visual evoked potentials in 84%. Orbital imaging showed moderate to severe apical crowding in 95% of the orbits and intracranial fat prolapse in 24.2%. Median best corrected visual acuity improved from 0.4 to 1.0 after one year of treatment (p < 0.001). We noted more improvement in vision with the use of decompressive surgery than with non-surgical methods (p < 0.05). Recurrences occurred in 7 patients who had not received orbital radiotherapy.

Conclusions

Visual field defects and apical crowding seen on orbital imaging were the most sensitive indicators for the detection of DON. Treatment with intravenous steroids pulse therapy, radiotherapy and orbital decompression effectively improved visual outcomes in cases of DON.     

Changes in peripapillary blood vessel density in Graves’ orbitopathy after orbital decompression surgery as measured by optical coherence tomography angiography

The purpose is to evaluate the utility of optical coherence tomography (OCT) angiography in the evaluation of Graves’ orbitopathy (GO) and response to orbital decompression in patients with and without dysthyroid optic neuropathy (DON). This was a single-center, prospective case series in a cohort of 12 patients (24 orbits) with GO and ±DON, (6 orbits) who underwent bilateral orbital decompression. All patients underwent pre- and postoperative OCT angiography of the peripapillary area. Vessel density indices were calculated in a 4.5 mm × 4.5 mm ellipsoid centered on the optic disk using split-spectrum amplitude decorrelation angiography algorithm, producing the vessel density measurements. Mean change in vessel density indices was compared between pre- and postoperative sessions and between patients with and without DON. Patient 1, a 34-year-old male with GO and unilateral DON OD, showed a significant reduction in blood vessel density indices oculus dexter (OD) (DON eye) after decompression while a more modest reduction was found oculus sinister (OS) with the greatest change noted intrapapillary. Patient 2, a 50-year-old male with DON OU, showed worsening neuropathy following decompression OD that was confirmed by angiographic density indices. Patient 3, a 55-year-female with DON, showed a reduction in blood vessel density OD and increased density OS. Patients without DON showed overall less impressive changes in indices as compared to those with DON. Using OCT angiography, response to surgical treatment in GO orbits, more so in orbits with DON, can be demonstrated and quantified using vessel density indices with reproducibility.     

眶内血肿28例临床分析

目的探讨眶内血肿的病因、诊断和治疗。方法回顾分析资料完整的28例(28眼)眶内血肿。其中,眼眶血管性病变12例,自发性6例,外伤性5例,手术后并发4例,血小板减少1例。均有不同程度的视力下降、眼球突出、眼球运动障碍及眶压升高。结果2例经急诊药物治疗,7例经眶内穿刺抽血,19例经开眶手术。患眼眼球运动、突出度均有好转,眶压下降,视力部分改善。结论对眶内血肿早期穿刺抽血或开眶手术等效果良好;由眼眶血管性病变等所致者需同时处理原发病变。