两种术式治疗甲状腺相关眼病上睑退缩的比较

目的对比两种术式矫正甲状腺相关眼病上睑退缩的临床疗效。方法将22例(32只眼)甲状腺相关眼病上睑退缩患者,随机分为A、B两组。A组11例18只眼采用上睑提肌中央腱膜切断术矫正;B组11例14只眼采用上睑提肌和Muller肌延长术矫正。术后随访6个月,评价其临床疗效。结果所有患者术后自觉症状均明显减轻或消失,A组及B组各自术前与术后疗效相比,均有统计学意义(P<0.01),组间比较无统计学意义(P>0.05)。术后6个月A组有4例6眼,B组有1例1眼上睑回退,经卡方检验,回退率组间比较有统计学意义(P<0.05)。两组均无一只眼过矫。结论两种术式均可有效矫正静止期甲状腺相关眼病的上睑退缩,但上睑提肌和Muller肌延长术回退率低。

Two surgical methods to modify upper eyelid retraction with thyroid associated-ophthalmopathy

ObjectiveTo evaluate the treatment effect of the two surgical methods for upper eyelid retraction with thyroid associated-ophthalmopathy. Methods Twenty-two patients(32 eyes) with inactive thyroid associated-ophthalmopathy were divided into 2 groups(11 for each group) randomly. 11 patients (18 eyes) in the group A were treated by central tenotomy of levator aponeurosis. Another 11 patients (14 eyes) in the group B were treated by lengthening of Mullers' muscle combined with levator muscle. The treatment effect was investigated in 6-month follow-up study. Results All of the patients were improved with the two surgical methods, which there was very significant difference before and after the treatments(P<0.01), but not between the two surgical methods(P>0.05)by statistical analysis. There was recurrent retracting in 4 patients (6 eyes) of group A and in 1 patient (1 eye) of group B, which there was significant difference between the two groups(P<0.05)by Chi-square test. None of the patients was overcorrected. ConclusionsThe two methods are both effective and safe in correcting upper eyelid retraction. The rate of recurrent retracting is lower in lengthening of Mullers' muscle combined with levator muscle than that in central tenotomy of levator aponeurosis.