以眼外肌截短術治療甲狀腺眼病變相關之斜視

Extraocular Muscle Resection for Strabismus Correction in Dysthyroid Ophthalmopathy

鄭涵之(Han-Chih Cheng) ； 賴慧群(Hui-Chun Lai) ； 高玲玉(Ling-Yuh Kao) ； 馬俐(Lih Ma) ； 黃鐘瑩(Chung-Ying Huang) ； 薛珮吟(Pei-Yin Hsueh) ； 林耕國(Ken-Kuo Lin) ； 楊孟玲(Meng-Ling Yang)

《中華民國眼科醫學會雜誌》 49卷3期 (2010/09) Pp. 337-342

https://doi.org/10.30048/ACTASOS.201009.0011

摘要

目的：評估以眼外肌截短(resection)手術來治療甲狀腺眼病變相關斜視的效果，並與傳統眼外肌徙後術(recession)的結果相比較。
方法：我們回溯收集本院2003年到2008年間，因甲狀腺眼病變造成斜視而接受眼外肌手術的病例。並紀錄其眼球運動限制或複視的持續時間、甲狀腺功能異常的持續時間、手術方法、術前和術後眼科檢查的各項結果、是否接受過眼窩減壓術、以及追蹤的時間。
結果：在51位病人中共有95條肌肉接受了徒後手術，依序是下徙直肌42條(44.2%)、內直肌28條(29.5%)、上直肌21條(22.1%)、及外直肌4條(4.2%)。接受一次或一次以上肌肉徙後術的成功率為79.6%。12位病人除了肌肉徙後手術外，並接受了肌肉截短手術。接受截短手術的肌肉共15條，分別是外直肌10條(66.7%)、上直肌3條(20.0%)、和內直肌2條(13.3%)。整體而言，病人在經過平均1.7次（標準差±0.9，範圍1-4）的手術、平均25.5±19.5個月（1至83個月）的追蹤之後，90.2%的病人能夠在正視時沒有複視（包括使用稜鏡眼鏡的輔助）。
結論：對部分斜視角度較大的甲狀腺眼病變病人，當重複肌肉徙後手術仍無法達到滿意的矯正效果時，若施行肌肉截短手術，可以得到安全和有效的結果。

並列摘要

Purpose: To evaluate the effect of extraocular muscle resection surgery in the correction of the strabismus in dysthyroid opthalmopathy and compare this with traditional extraocular muscle recession surgery.
Method: Retrospective study design. Fifty-one patients received extraocular muscle surgery for strabismus related to dysthyroid ophthalmopathy in Chang-Gung Memorial Hospital from 2003 -2008. Restriction of eye movements, duration of diplopia, history of orbital decompression, strabismus correction methods, and preoperative and postoperative ocular examinations were recorded.
Result: Of the 51 patients, ninety-five muscles were recessed. There were 42 inferior rectus muscles (44.2%), 28 medial rectus muscles (29.5%), 21 superior rectus muscles (22.1%), and 4 lateral rectus muscles (4.2%). The success rate of recession surgery was 79.6%. Twelve of the patients had additional resection surgery on 15 muscles. After a mean of 1.7 operations and a mean of 25.5±19.5months (1-83months) follow-up time, 90.2% patients could view a single image without diplopia with a straight gaze.
Conclusion: When repeated extraocular muscle recession surgery cannot provide satisfactory strabismus correction results, additional extraocular muscle resection surgery might be a safe and effective substitute method for some patients.

並列關鍵字

dysthyroid ophthalmopathy ； recession ； resection