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甲狀腺眼症病患快速眼球運動速度之分析
Analysis of Saccadic Eye Movement in Patients of Graves' Ophthalmopathy
摘要
甲狀腺眼症造成的眼部病變可從最輕微的無症狀至最嚴重的視力喪失。對於眼球運動方面，向於甲狀腺眼症主要造成眼外肌之肥厚，纖維化及眼窩內組織粘度增加，因此會影響眼球運動。本篇報告研究二十六位甲狀腺眼症患者之快速眼球運動，計算最高速度及潛伏期，並分析臨床症狀如複視，眼球運動不良，突眼，眼外肌肥厚與快速眼球運動變化之關係。結果顯示，整體而言，甲狀腺眼症患者之垂直快速眼球運動速度減慢。臨床症狀方面，有複現症狀患者之垂直快速眼球運動變慢；眼球運動不良者則水平及垂直之快速眼球運動速度均變慢；突眼則無一致性變化。最有意義的發現為電腦斷層攝影証實有眼外肌肥厚之患者，肥厚肌肉作用方向之快速眼球運動速度呈一致性變慢，表示眼外肌病變確實會影響眼球運動。本篇研究提出一數據化之臨床檢查方法供醫師們評估甲狀腺眼症之嚴重程度，值得推廣。
關鍵字
無資料並列摘要
Graves' ophthalmopathy is a kind of autoimmune disease with unknown etiology. It can result in a lot of ocular manifestations such as lid retraction, lid lag, exophthalmos, limitation of extraocular movements, corneal exposure, elevated intraocular pressure, optic nerve compression and sight loss. For the EOM limitations, the major cause is hypertrophy and fibrosis of the extraocular muscles. Histopathological study reveals glycosaminoglycan accumulation and mononuclear cells infiltration in the extraocular muscles. We studied and analysed the peak velocity (PVs) changes in patients with graves' ophthalmopathy. Twenty-six patients and nineteen normal controls were enrolled in this study. The PVs and latencies of thirty degrees horizontal and vertical saccade eye movements were recorded and calculated using electronystagmography. In general, the PVs of vertical saccade decreased significantly. Patients wills symptoms of diplopia shows decreased vertical PVs and patients with symptoms of EOM limitation shows decreased both horizontal and vertical PVs. Exophthalmos is not a good predictor of PVs changes. For individual muscle, each hypertrophic muscle has decreased PV to the direction of the action of muscle. In conclusion, saccade velocity test is a sensitive, reliable, non-invasive, quantifing test for Graves' ophthalmopathy. It provides scientific data for clinician to judge the severity and activity of this disease, It cats be used routinely for the most benefit of patients.