[Multi-wall orbital decompression for disfiguring proptosis in patients with mild or moderate thyroid eye disease].

: 目的： 观察经结膜和双重睑皮肤切口的内、下及外壁减压术改善甲状腺相关眼病（TAO）眼球突出及外观损伤的疗效及安全性。 方法： 回顾性系列病例研究。收集2013年12月至2015年12月间武警总医院眼眶病研究所收治的静止期TAO患者18例（28只眼）的临床资料，男、女各3和15例，年龄19~45岁（平均年龄30岁）。患者均行微创多壁眼眶减压术，手术目的为缓解眼球突出，缩小睑裂宽度，消除眶周肿胀。纳入标准：（1）Hertel眼突计测量值14~23 mm；或较对侧眼突出2~7 mm；（2）眼部病情静止且甲状腺功能正常6个月以上；（3）指试眶压正常或（+）。记录手术前、后最佳矫正视力，眼球突出度，上、下睑缘至角膜中央的距离，复视程度。术后3个月复查CT。比较手术前、后眼球突出度，上、下睑缘至瞳孔中央的距离，采用配对t检验；手术前、后复视变化采用Wilconxon检验。 结果： 患者手术前、后眼球突出度分别为（19.2±2.3）mm和（14.7±1.4）mm，平均回退（4.6±1.7）mm，差异有统计学意义（t=14.08，P<0.01）。手术前、后瞳孔中央至上睑缘距离分别为（5.1±1.2）mm和（4.9±1.3）mm，上睑退缩改善（0.2±0.5）mm，差异无统计学意义（t=1.73，P=0.095）。手术前、后瞳孔中央至下睑缘距离分别为（5.9±0.9）mm和（4.3±0.7）mm，平均回退（1.6±0.8）mm，差异有统计学意义（t=10.09，P<0.01）。术后双眼突出度差值为0~2.5 mm，中位数1.0 mm。无术后第一眼位新发复视，2例周边新发复视，2例术后复视得到改善，手术前、后复视程度的差异无统计学意义（Z=743.00，P=0.458）。 结论： 该术式可控性好，安全有效且并发症少，能缓解轻、中度眼球突出，改善下睑退缩，消除眶周肿胀，切口美观隐蔽。（中华眼科杂志，2017，53：128-135）. INCLUSION CRITERIA: 1. Hertel value was 14-23 mm or over 2-7 mm than contralateral eye; 2.Orbitalpathy has been inactive with normal thyroid function for at least 6 months; 3.Orbital pressure is normal or (+). Clinical outcomes were recorded including best-corrected visual acuity, exophthalmometry, margin-to-central distance of upper and lower lids, diplopia, and CT scans before and 3 months after surgery. Results: The mean protosis of pre-and postoperation were (19.2±2.3) mm and (14.7±1.4) mm with mean reduction was (4.6±1.7) mm (t=14.08, P<0.01). Margin-to-central distance of the upperlid of pre- and postoperation were (5.1±1.2) mm and (4.9±1.3) mm with mean reduction was (0.2±0.5) mm (t=1.73, P=0.095). Margin-to-central distance of the lowerlid of pre-and postoperation were (5.9±0.9) mm and 4.3±0.7 mm with mean reduction was (1.6±0.8) mm (t=10.09, P<0.01). The difference of bilateral exophthalmos after surgery is 0-2.5 mm (median=1 mm). None of the patients showed new-onset diplopia at primary gaze and two patient showed surrounding gaze diplopia postoperatively. Two patients with diplopia relieved after surgery (Z=743.00, P=0.458). Conclusions: Transconjunctival and transpalpebral medial, inferior, and lateral walls decompression with a hidden incision was a controllable, safe, effective technique with minimal complications in relieving not only mild, moderate proptosis, but also retraction of lowerlid, and swollen eyelids. (Chin J Ophthalmol, 2017, 53: 128-135).