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.     

甲状腺相关眼病眼眶减压术的疗效分析

目的：探讨眼眶减压术在甲状腺相关眼病中治疗的价值。方法：回顾性分析中山眼科中心1993－2000年27例（30只眼）经全身和眼部临床检查（视力、视野或视觉诱发电位等）确诊为甲状腺相关眼病患者采用眼眶减压术（一壁、二壁及三壁减压）治疗的临床资料,观察其手术前和手术后患者视力、眼球突出度及眼球运动的变化。术后随访2个月至7年,平均13．7个月。结果：视力：19只眼（63．3％）明显提高;4只眼（13．3％）轻度提高,视力均保持在0．2－0．8;4只眼（13．3％）视力无变化,其中3只眼（10．0％）视力下降。24只眼（80．0％）眼球突出后退≥3．0mm,28只眼（93．3％）眼球突出后退≥2．0mm,平均眼球突出后退3．6mm。结论：眼眶减压术可提高甲状腺相关眼病患者的视力,减轻其眼球突出度。     

甲状腺相关眼病的眼眶减压术治疗现状

甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)是成人最常见的眼眶病之一.对患者和医生来说,TAO的治疗仍然是个难题.主要的治疗选择有眼眶减压术、全身应用糖皮质激素和放疗.一些TAO患者可能需要手术来缓解眼部症状,近年来眼眶减压术用于越来越多的患者,它可以有效而安全地改善TAO患者的外观,并减轻患者眼的暴露症状和其他不适.     

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.     

眼眶减压术对甲状腺相关眼病患者脉络膜厚度的影响

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....     

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。     

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。     

眶脂肪脱出术治疗甲状腺相关眼病

目的 :回顾和评价眶脂肪脱出术治疗甲状腺相关眼病眼球突出的疗效。方法 :经眼睑或结膜切口入路 ,切除肌肉圆锥内、外的脂肪 ,达到降低眶压 ,减少眼球突出度的目的。结果 :切除眶脂肪 1 5～ 11ml,平均 3 9ml,矫正眼球突出度 2～ 6mm ,平均 3 1mm。该治疗副作用很少 ,不影响视力及眼球运动 ,与提上睑肌延长术联合效果更佳。结论 :眶脂肪脱出术可以缓解眼球突出 ,是治疗甲状腺相关眼病性突眼的有效方法     

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。     

The effect of intravenous high-dose glucocorticoids and orbital decompression surgery on sight-threatening thyroid-associated ophthalmopathy

AIM: To report the effects of intravenous high-dose glucocorticoids (ivGC) and orbital decompression (OD) surgery for treatment of sight-threatening thyroid-associated ophthalmopathy (TAO). METHODS: A retrospective review of medical records from patients with sight-threatening TAO [definite or highly suspected dysthyroid optic neuropathy (DON)] treated with ivGC (60 cases) and OD (25 cases) was conducted at the Zhongshan Ophthalmic Center between January 2001 and January 2009. Patients were initially treated with ivGC (ivGC group). If no significant improvement in visual function was obtained, they then received OD surgery (OD group). The pre- versus post-treatment efficacies of either ivGC or OD in these patients were assessed using several indices, including visual acuity, intraocular pressure, ocular alignment, ocular motility, and exophthalmos. RESULTS: Nighty-one eyes had definite DON while 79 were considered to have highly suspected DON. In the ivGC group, 51 individuals (85.0%) eventually demonstrated normal vision, while 10 patients (16.7%) demonstrated a reduction in deviation (P<0.01), and 35 cases (58.3%) showed slight improvements in ocular motility (P<0.01). In OD group, visual acuity improved in 24 cases (96.0%, P<0.01) and all patients showed varying reductions of exophthalmos (mean: 4.35±1.13 mm, P<0.01). Eight cases (32.0%) experienced an 8-15 PD reduction of deviation and ocular motility improved in 12 cases (48.0%), while 3 patients (12.0%) developed new-onset strabismus with diplopia post-surgically (P<0.01). Patients were followed up at an average of 1.55±1.07y. CONCLUSION: Both ivGC and OD show good therapeutic efficacy in the treatment of sight-threatening TAO. The presence of extremely poor eyesight (≥0.5logMAR) was corrected in some patients with ivGC alone, thus sparing these patients from subsequent OD surgery. In patients who were refractory to steroids, subsequent OD surgery often provided satisfactory outcomes, however, new-onset strabismus with diplopia was observed in 12.0% of these cases.     

眼眶成纤维细胞与甲状腺相关眼病

研究表明,眼眶成纤维细胞在甲状腺相关眼病的发生和发展中起中心作用,既是靶细胞,同时又是效应细胞,现就这两方面作用作一综述。     

Orbital decompression surgery and horse chestnut seed extract improved superior orbital vein blood flow in patients with thyroid-associated ophthalmopathy

AIM: To evaluate the efficacy and safety of orbital decomposition (OD) surgery in combination with horse chestnut seed extract (HCSE), as compared to OD alone, in patients with thyroid-associated ophthalmopathy (TAO). METHODS: Sixty-two orbits from 62 TAO patients were randomly assigned to OD or OD+HCSE at 1:1 ratio (31 received OD alone, 31 received OD+HCSE). Forty-two orbits from 21 healthy subjects were used as controls. Complete ophthalmic examination and color Doppler flow imaging (CDFI) were performed before surgery and 3mo post-surgery on all 62 orbits from the TAO patients. CDFI were also performed on the 42 control orbits. The effect of OD+HCSE and OD alone on TAO orbits was compared on several endpoints, including superior ophthalmic vein blood flow (SOVBF) parameters, subjective assessment, soft tissue involvement, lid retraction, diplopia, eye movement restriction, degree of exophthalmos, and intraocular pressure. The control orbits were used as reference for the SOVBF parameters. RESULTS: OD surgery with or without HCSE improved SOVBF, symptoms and soft tissue involvement, decreased degree of exophthalmos and intraocular pressure in orbits of TAO patients. The OD+HCSE combination led to significantly better improvement of SOVBF than OD alone. The differences between the reductions of SOVBF in the two groups are 1.26 cm/s in max-volecity and 0.52 cm/s in min-volecity (P<0.0001). CONCLUSION: SOVBF is significantly reduced in the orbits affected with TAO, indicating that congestion may be an important factor contributing to TAO pathogenesis. OD surgery improves the SOVBF, and combination of HCSE medication and OD surgery further improved venous return than OD surgery alone.     

眼眶成纤维细胞在甲状腺相关性眼病发病机制中的作用

甲状腺相关性眼病的发病机制尚不十分明确.研究表明,此病发病过程中眼眶成纤维细胞既是自身免疫靶细胞,又是效应细胞,是其发病的关键因素.眼眶成纤维细胞自身抗体表达、氧化应激反应在甲状腺相关性眼病中起重要作用,通过对此方面的研究,探索对甲状腺相关性眼病有潜力的新的治疗方法.     

The role of cell mediated immunopathogenesis in thyroid-associated ophthalmopathy

Currently, thyroid-associated ophthalmopathy (TAO) lacks effective treatment due to our lack of clarity in its immunopathogenesis. Orbital fibroblasts play a key role in altering inflammation and immune response in TAO, and are considered as the key target and effector cells in its pathogenesis. The orbit infiltrating CD34+ fibrocytes add on to the process by expressing high levels of autoantigens and inflammatory cytokines, while also differentiating into myofibroblasts or adipocytes. This review focuses on the role of orbital fibroblasts and CD34+ fibrocytes in the pathogenesis of TAO, highlighting the basis of emerging treatments.     

眼眶减压术治疗Graves眼病的临床效果

目的:探讨眼眶减压术治疗Graves眼病的效果及安全性.方法:选取2011-02/2016-02在我院治疗的Graves眼病患者55例77眼,均行眼眶减压术治疗,观察患者术后6 mo视力、眼球突出度及并发症.结果:患者术后6 mo最佳矫正视力(0.23±0.09)明显较术前(0.46±0.07)有所提高,差异有统计学意义(P<0.05);患者术后6 mo眼球突出度(16.20±1.99 mm)明显较术前(20.13±1.87mm)有所减少,差异有统计学意义(P<0.05);术后CAS评分≤3分眼数为56眼(73%),明显较术前15眼(19%)有所增加,差异有统计学意义(P<0.05);术前共有50眼(65%)存在色觉障碍,术后有42眼(55%)视觉障碍明显改善,8眼(10%)无变化;77眼术后6 mo眼球突出度平均下降3.87±1.03 mm;术后出现新复视患者5例8眼,新发复视率10%,随访3 mo后,复视消失.结论:眼眶减压术治疗Graves眼病是一种有效方法,但应注意术后复视等并发症发生.     

透明质酸与甲状腺相关眼病

甲状腺相关眼病中重要的病理表现为糖胺聚糖在眶后组织中的聚集,从而出现复视、眼球突出、上睑挛缩等各种临床表现,其中透明质酸作为糖胺聚糖的主要成分在甲状腺相关眼病的病理过程中发挥了重要作用。本文就透明质酸和甲状腺相关眼病的关系作一综述。     

甲状腺相关眼病组织病理学研究

目的:探讨甲状腺相关眼病组织病理学改变。方法:收集我院2000/2005经症状、体征、甲状腺功能和CT证实为甲状腺相关眼病,并行眼眶减压术或复视矫正术的TAO患者共21例,行HE染色,Masson染色和阿辛蓝染色,观察TAO的病理学改变。结果:HE染色可见脂肪间隙增宽,间质伊红红染,纤维隔形成,肌纤维断裂,纤维化,淡染,部分溶解,空泡形成,Masson染色可见肌肉间质蓝染,脂肪组织血管增多,间质蓝染;阿先蓝染色可见脂肪间质蓝染。结论:甲状腺相关眼病主要组织病理学改变有脂肪间隙增宽,纤维隔形成,血管新生;肌纤维不同程度肌浆凝集,肌纤维断裂,纤维化,淡染,部分溶解,空泡形成。急性期可见糖胺聚糖沉积,肌束间炎性细胞浸润。