直肌后徙联合后部巩膜缝线悬吊固定术治疗甲状腺相关眼病限制性斜视

目的：探讨甲状腺相关眼病(thyroid associated ophthalmopathy，TAO)致限制性斜视患者行直肌后徙联合后 部巩膜缝线悬吊固定术后的斜视度、复视图及双眼视觉功能的变化。方法：选择2010年7月至2013年6月于中南大学 湘雅医院眼科诊治的因TAO导致限制性斜视行手术治疗的患者18例(19只眼)，8例(8只眼)为限制性下斜视，行下直肌 徙后术；5例(5只眼)为限制性上斜视，行上直肌徙后术；2例(2只眼)为限制性内上斜视，分次行上直肌徙后及内直 肌徙后术；3例(4只眼)为限制性内斜视，行内直肌徙后术。其中2例(下斜视1例，内斜视1例)为眼眶减压术后患者， 二期行眼外肌徙后术。所有患者均行直肌后徙联合后部巩膜缝线悬吊固定术。手术前和手术后均进行斜视度、复视 图及立体视觉检查，并进行对照比较。结果：18例患者均随访6个月以上。手术前斜视度为20Δ~80Δ，术后斜视度为 2Δ~10Δ；术前16例患者第一眼位有复视，术后14例患者第一眼位及下转15°方位复视消失，2例患者第一眼位复视消 失，下方视野残留复视症状；术前具立体视觉患者2例，术后具立体视觉患者增至14例，各项指标术后与术前比较， 差异均具有统计学意义(均P<0.05)。结论：TAO导致限制性斜视患者行直肌后徙联合后部巩膜缝线悬吊固定术可有效 改善斜视度，消除复视，有助于提高患者的生活质量。

Treatment of rectus recession-suspension on posterior sclera surgery for restrictive strabismus in thyroid associated ophthalmopathy

Objective: To evaluate the oblique angle, diplopia and stereoacuity before and after rectus recession-suspension on posterior sclera surgery in patients with restrictive strabismus caused by thyroid associated ophthalmopathy (TAO). Methods: Data from 18 patients (19 eyes) with restrictive strabismus caused by TAO, who underwent rectus recession-suspension on posterior sclera surgery from July 2010 to June 2013 in Xiangya Hospital, Central South University, were analyzed retrospectively. Eight patients (8 eyes) or 5 patients (5 eyes) with hypotropia were operated with inferior rectus recession or superior rectus recession. Two patients (2 eyes) with esohypertropia or 3 patients (4 eyes) with esotropia were operated with inferior rectus recession plus medial rectus recession or medial rectus recession. Two patients (1 hypotropia, 1 esotropia) underwent orbital decompression surgery before strabismus surgery. All patients were performed rectus recession-suspension on posterior sclera surgery, and the oblique angle, diplopia view and stereopsis test were examined before and after the operation. Results: All patients were followed up for more than 6 months. The preoperative prism were 20△- 80△ and postoperative prism were 2△-10△. There was diplopia on the primary position before surgery in 16 patients. After surgery, the diplopia in 14 patients disappeared on the primary and 15° down gaze, and 2 patients had not diplopia on the primary position but residual diplopia on inferior field. Two patients had stereopsis before surgery, and the numbers of patients raised to 14 after surgery. Compared with pre-operation, changes of the above measured indexs in post-operation were significant difference (all P<0.05). Conclusion: The rectus recession-suspension on posterior sclera surgery is effective to improve oblique angle and diplopia in restrictive strabismus caused by TAO, which can improve patient’s living quality.