Transnasal Endoscopic Approach for Orbital Decompression of Thyroid Orbitopathy-Case Report

以內視鏡經鼻腔行甲狀腺突眼減壓術―病例報告

張丞賢(Cheng-Hsien Chang) ； 王惠珠(Hwei-Zu Wang) ； 戴志峰(Chih-Feng Tai)

《中華民國眼科醫學會雜誌》 38卷1期 (1999/03) Pp. 92-96

https://doi.org/10.30048/ACTASOS.199903.0014

摘要

本文報告一甲狀腺突眼症，經鼻腔以內視鏡行眼窩減壓術合併外側減壓術之成功病例。一名45歲男性病人因長期甲狀腺亢進造成突眼及眼瞼收縮。右眼也因此角膜潰瘍而必須轉診來之前接受眼瞼緣縫合術。經過一段時間之口服類固醇及人工淚液點眼治療之後，我們給予病人雙眼之眼窩減壓術。兩邊皆以外側眼眶切開術行外側眼窩減壓術合併內側及部分眼窩底減壓術。而在右側則經皮下行篩房切除術來做內側及眼窩底減壓術；而左側則經鼻腔以內視鏡行減壓術。四個月後，無眼外肌及眼球轉動障礙，因此接著行左右兩眼上、下眼瞼放鬆術。術後追踪六個月右眼最佳矯正視力從術前可辨手指數進步至0.4。而左眼則維持術前0.9。兩眼突眼術後均減少6毫米。術後無雙眼複視及其他後遺症。

並列摘要

A 45 year-old male patient suffered from a severe proptosis and eyelid retraction due to long-term hyperthyroidism. Atrophic corneal ulcer occurred in his right eye, and a partial lateral tarsorrhaphy was done in that eye before referral to out clinic. After a period of medical treatment with oral prednisolone and artificial tear eyedrops, orbital decompression was scheduled. Bilateral lateral orbits were decompressed in conjunction with inferomedial wall decompressions. In the right orbit, an external ethmoidectomy was done, while in the left, a transnasal endoscopic approach was used to remove the inferomedial wall. Four months after the decompression, no morbidity of the extraocular muscles or other complications ensued. So, bilateral recessions of upper and lower eyelid were done. In a follow up of 6 months, the vision of the right eye returned from counting finger preoperatively to 0.4 best corrected. The vision of the left eye remained the same at 0.9. Proptosis was reduced for 6mm by the Hertel exophthalmometry on both eyes. There was no binocular diplopia or other complications.

並列關鍵字

Thyroid orbitopahty ； Decompression ； Endoscope