甲状腺相关性眼病行内镜下内侧壁眶减压联合脂肪减压术后眼眶各容积参数的变化

Changing of the orbital volume after endoscopic transethmoid medial wall decompression combined with the endoscopic transethmoid intraconal fat-removal orbital decompression in thyroid associated ophthalmopathy

摘要:

目的??初步观察甲状腺相关性眼病（TAO）行内镜下内侧壁眶减压联合脂肪减压术后眼眶各容积参数的变化。方法?回顾分析2014年9月-2015年8月于温州医科大学附属眼视光医院由于眼球突出影响外观而行内镜下内侧壁眶减压联合脂肪减压术的TAO患者11例（20眼），所有患者确诊为非组织活动期至少6个月，均因眼球突出影响外观而行手术治疗。所有患者术前和术后第3个月行高分辨率CT（HRCT）。运用眼眶CT结合计算机辅助测量软件测量眼球突出度，分析TAO手术前后眼眶各容积参数变化情况，并分析与眼球回退值之间的关系。结果?术后眼球突出度较术前有明显降低；手术后内直肌容积（MMV）、球后脂肪容积（FV）、眼眶容积（OV）较术前有增加；手术前后眼外肌容积的变化值（?MV）与眼球回退值呈负性相关，眼眶容积变化值（?OV）与眼球回退值也呈负性相关。结论?术后3个月内直肌的增粗，可能与手术干扰、术中去除内侧壁有关。眼外肌体积变化和眼眶容积变化与眼球突出度回退之间存在显著的负相关性。

Abstract:

Objective?To present the changing of the parameters of orbital volume after endoscopic transethmoid medial orbital wall decompression combined with the endoscopic transethmoid intraconal fat-removal orbital decompression in thyroid associated ophthalmopathy (TAO).?Methods?A retrospective chart was reviewed in 11 patients (20 eyes) receiving orbital decompression for the treatment of exophthalmos secondary to TAO from September 2014 to August 2015. All patients diagnosed TAO were in stable and inactive phase at least for 6 months. High-resolution computed tomography (HRCT) scan were performed in all patients before and 3-month after surgery. CT scan of orbit and computer-aided measurement software were used to measure the exophthalmos. Changing of the parameters of orbital volume were recorded for analysis its relationship with the amount of proptosis reduction.?Results?The exophthalmos was significantly decreased after surgery. Medial rectus volume, fat volume and orbital volume were larger postoperatively. The changing of rectus volume and fat volume both had negative correlationship with the amount of proptosis.?Conclusions?The thickening of medial rectus 3-month postoperative may due to the removing of medial wall of orbit during the surgery. The stimulation of the surgery may be another reason. The changing of rectus volume and fat volume both had negative correlationship with the amount of proptosis.