钱海华，廖友生

作者单位：(641100)中国四川省内江市第二人民医院眼科



·临床研究·

TAO致限制性斜视患者行直肌后徒联合后部巩膜缝线悬吊固定术的疗效

钱海华，廖友生

作者单位：(641100)中国四川省内江市第二人民医院眼科

Effect of rectus recession combined with the rear suspension scleral fixation in patients with restrictive strabismus caused by thyroid associated ophthalmopathy

Hai-Hua Qian, You-Sheng Liao

Department of Ophthalmology，the Second People’s Hospital of Neijiang, Neijiang 641100, Sichuan Province，China

Correspondence to:Hai-Hua Qian. Department of Ophthalmology，the Second People’s Hospital of Neijiang, Neijiang 641100, Sichuan Province，China. 892717582@qq.com

Received：2015-07-23Accepted：2016-03-17

Abstract

•AIM: To investigate the therapeutic effect of rectus recession combined with the rear suspension scleral fixation for patients with restrictive strabismus caused by thyroid associated ophthalmopathy (TAO).

•METHODS: The clinical data of 48 patients (71 eyes) with severe TAO were retrospective analyzed from January 2013 to January 2015.The patients with severe TAO were divided into the exophthalmos (EM) group with 25 patients (35 eyes), compressive optic neuropathy (CON) group with 12 patients (20 eyes) and exposure keratopathy (EK) group with 11 patients (16 eyes).The rectus recession combined with rear suspension scleral fixation treatment was performed in all patients. The visual acuity, clinical activity score (CAS), and diplopia situation of each group were recorded and compared preoperatively and at 6mo postoperatively.

•RESULTS: The postoperative best corrected visual acuity (BCVA) of the three groups were significantly higher than those before operation (P<0.01). The postoperative exophthalmos of CON group, MP group and EK group were significantly more improved than those before operation (P<0.01). The eyeballs of patients in CON group retracted significantly more than the other two groups (P<0.01). The CAS was significantly lower after operations than that before operations (P<0.01). The diplopia in patients in CON group decreased more than the other two groups(P<0.05).

•CONCLUSION: Rectus recession combined with the rear suspension scleral fixation can help improve the restrictive strabismus caused by TAO, visual acuity, eyeballs to roll back, eliminate the diplopia and to improve the life quality of patients.

KEYWORDS:•thyroid associated ophthalmopathy; rectus recession; rear suspension scleral fixation; efficacy

Citation:Qian HH, Liao YS. Effect of rectus recession combined with the rear suspension scleral fixation in patients with restrictive strabismus caused by thyroid associated ophthalmopathy.GuojiYankeZazhi(IntEyeSci) 2016;16(4):735-737

摘要

关键词：甲状腺相关性眼病；直肌后徙；后部巩膜缝线悬吊固定术；疗效

引用：钱海华，廖友生.TAO致限制性斜视患者行直肌后徒联合后部巩膜缝线悬吊固定术的疗效.国际眼科杂志2016;16(4):735-737

0引言

甲状腺相关性眼病(thyroid associated ophthalmopathy，TAO)属于自身免疫性疾病，自身免疫反应会攻击眼外肌及眶脂肪，炎性水肿及纤维化会增加眶内容物，使得眼眶内压力增加，静脉回流受阻，从而加重组织水肿及自身免疫反应，形成恶性循环，加重继发性压迫性神经病变症状及破坏眼角膜，并最终危及患者视力[1-2]。近年相关研究指出[3]，手术能有效恢复TAO患者视力，消除患者复视，促使眼球回退，有利于提高患者生活及工作质量。本研究拟采用直肌后徙联合后部巩膜缝线悬吊固定术治疗TAO限制性斜视，并观察患者手术前后视力、临床活动性评分及复视的变化。

1对象和方法

1.1对象收集2013-01/2015-01在本院眼科就诊，经实验室检查、临床体格检查及影像学检查确诊为重度TAO的48例71眼患者的临床资料，其中男28例44眼，女20例27眼，年龄18～74(平均45.5±3.5)岁。根据TAO类型将患者分为眼球高度突出(exophthalmos，EM)组25例35眼，压迫性视神经病变(compressive optic neuropathy，CON)组 12例20眼及暴露性角膜病变组(exposure keratopathy，EK)11例16眼。诊断标准：(1)CON组：1)最佳矫正视力近3mo内急剧减退或严重下降，视乳头水肿，相对性瞳孔传入障碍，色觉异常，表现为色盲或色弱；……