重新认识眼眶减压术对甲状腺相关眼病的治疗价值

摘要

甲状腺相关眼病引起的压迫性视神经病变和暴露性角膜病变是眼眶减压术的经典适应证.近年研究认为,该术式对于缓解眼球突出、合并充血性病变、眼压升高、激素治疗效果差或不能耐受者均具有重要的治疗价值.新的治疗价值对手术的安全性和有效性提出了更高要求,需要术者能够制定梯度减压方案,并改进骨壁切除的范围.目前认为深外侧壁为首选,严重病例可联合内壁和下壁减压.手术切口应以结膜、重睑皱褶或借助内窥镜为主,尽量避免皮肤瘢痕.脂肪切除减压术是骨性减压的补充,但应以眶周脂肪为主,并严格掌握适应证和切除量.制定个性化方案是该术式发展的必然趋势.%Compressive optic neuropathy and exposure keratopathy is classical indications of orbital decompression surgery for thyroid associated ophthalmopathy.Recently,its therapeutic value should extend to cosmetic requirement,the entity of congestive orbitopathy,ocular hypertension and hormonal resistance. In order to improve the safe and efficacy of orbital decompressions,we need the graded decompression plans and the modified areas of bone removal.The preferred area of bone removal is deep lateral wall.In serious patients,a combined medial,inferior and deep lateral wall decompression is recommended.There have also been technical advances in the cosmetic incisions such as transconjunctival,eyelid crease or endoscopic access.Removing periorbital fat is a supplement skill for bony decompression.The removed amount and indications should be regulated strictly.Individual operative project is the tendency of development of orbital decompressions.(Chin J Ophthalmol,2012,48:673-675 )