Change of Proptosis after Extraocular Muscle Surgery in Graves' Ophthalmopathy

葛瑞芙氐眼病變施行眼外肌手術後其突眼程度的改變

廖述朗(Chiu-Lang Liao) ； 高啟祥(Shing Chei-Shung Kao) ； 侯平康(Ping-Kang Hou)

《慈濟醫學雜誌》 8卷2期 (1996/06) Pp. 91-96

https://doi.org/10.6440/TZUCMJ.199606.0091

摘要

葛瑞芙氏眼病變是一種自體發炎反應造成的眼外肌發炎肥大，而導致臨床上幾個重要表徵如突眼、複視、眼瞼攣縮及視神經病變。一般治療採用階段性手術，先施行眼窩減壓術，接著是眼外肌手術，最後才是眼皮手術。本研想探討經過眼外肌手術，放掉眼外肌後，是否會影響突眼程度，而減少先前眼窩減壓術治療突眼的效果。
20個有複視之葛瑞芙氏眼變病人經眼外肌手術治療，我們記錄其術前、術後六個月突眼程度（用Hertel exophthalmometer量）。有14個病人單側眼開刀，其中只有2個病人6個月後其開刀眼及未開刀眼突眼改變程度相差大於2mm。統計上並無顯著意義（paired t test）。除此之外，有6個病人兩眼都接受眼外肌手術，只有一眼突眼改變程度大於2mm。由以上結果顯示，眼外肌手術後，其突眼程度並無顯著改變，目前用階段性手術來治療葛瑞芙氏眼病變依然是有用的。

關鍵字

葛瑞芙氏眼病變 ； 突眼 ； 眼窩減壓術 ； 眼肌放鬆術

並列摘要

Graves’ ophthalmopathy is an autoimmune inflammatory process affecting the extraocular muscles. The enlargement of these muscles is responsible for most of the important manifestations of Graves’ opthalmopathy including proptosis, diplopia, and optic neuropathy. The conventional order of staged treatment is 1) orbital decompression, 2) muscle surgery and 3) eyelid surgery. This study addressed whether the release of the extraocular muscles by surgery affects the degree of proptosis and hence dampens the retroplacement effect of orbital decompression.
Twenty cases of Graves’ ophthalmopathy with diplopia were corrected by muscle recession with an adjustable suture procedure. The degree of proptosis as measured by a Hertel exophthalmometer was recorded both preoperatively and six months postoperatively.
Fourteen patients were operated on unilaterally, but only two of them experienced a difference of proptotic change between both eyes of more than 2 mm six months postoperatively. There were no statistically significant changes between the surgically-treated eyes and the fellow eyes. (paired t test) Furthermore, in the six patients who received bilateral muscle recession, only one eye showed more than a 2 mm increase of proptosis six months postoperatively.
There is no significant change in the degree of proptosis following surgical recession of the extraocular muscles. Therefore, the present concept of staged operation seem to be valid.

並列關鍵字

Graves' ophthalmopathy ； proptosis ； orbital decompression ； muscle recession