CAJ | 학술논문

目的探讨下直肌后退术治疗甲状腺相关眼病性眼外肌病变的适应证、手术特点和效果等.方法回顾分析诊治的39例甲状腺相关眼病性眼外肌病变需作下直肌后退术的患者.其中男24例:女15例:年龄28.0～66.0岁(平均49.9岁).手术方式包括下直肌后退术31例;下直肌断腱术1例:下直肌后退+上白:肌缩短3例;下直肌后退+内直肌后退2例:右眼下直肌后退+左眼内直肌后退外直肌缩短1例;左眼下直肌后退+右眼上直肌后退下直肌缩短1例.术后平均随访1.4年.结果术后25例正位,复视消失;欠矫5～15°10例,复视明显改善:过矫4例.20°以内的下斜视行下直肌后退术每1mm后退平均可矫止2.5°.大度数垂直斜(20°～＞45.),78.9%(15/19)行患眼下直肌后退术可矫正;21.0%(4/19)需行下直肌断腱术或加患眼上直肌缩短术.所有大度数垂直斜均需作眼球缝线固定术.结论下直肌后退术治疗甲状腺相关眼病性眼外肌病变的限制性下斜视效果满意,文中对手术时机、手术特点、手术方式与手术注意点进行了详细的讨论.
목적 탐토하직기후퇴술치료갑상선상관안병성안외기병변적괄응증、수술특점화효과등.방법 회고분석진치적39례갑상선상관안병성안외기병변수작하직기후퇴술적환자.기중남24례:녀15례:년령28.0～66.0세(평균49.9세).수술방식포괄하직기후퇴술31례;하직기단건술1례:하직기후퇴+상백:기축단3례;하직기후퇴+내직기후퇴2례:우안하직기후퇴+좌안내직기후퇴외직기축단1례;좌안하직기후퇴+우안상직기후퇴하직기축단1례.술후평균수방1.4년.결과 술후25례정위,복시소실;흠교5～15°10례,복시명현개선:과교4례.20°이내적하사시행하직기후퇴술매1mm후퇴평균가교지2.5°.대도수수직사(20°～＞45.),78.9%(15/19)행환안하직기후퇴술가교정;21.0%(4/19)수행하직기단건술혹가환안상직기축단술.소유대도수수직사균수작안구봉선고정술.결론 하직기후퇴술치료갑상선상관안병성안외기병변적한제성하사시효과만의,문중대수술시궤、수술특점、수술방식여수술주의점진행료상세적토론.
Objective To study the indication,surgical management and effect of inferior rectus recession on the thyroid-related myopathy.Methods Thirty-nine patients of strabismus associated with thyroid-related myopathy who were managed by inferior rectus recession were retrospectively analyzed.Twenty-four patients were male and 15 were female,with their age ranging from 28 to 66 years old(mean,49.9 years).The strabismus surgery included recession of inferior rectus muscle(31 cases),myectomy of inferior rectus(1 case),recession of inferior rectus and resection of superior rectus(3 cases),recession of inferior rectus and medial rectus(2 cases),recession of inferior rectus of the right eye and recession of medial rectus and resection of lateral rectus of the left eye(1 case),inferior rectus recession of the left eye and recession of superior rectus and resection of inferior rectus of the right eye(1 case).The patients were followed up for an average of 1.4 year.Results Normal ocular alignment was obtained in 25 patients with no diplopia after operation,10 patients had an undereorrection of 5-15°and their diplopia was improved a lot,4 patients had surgical overcorrection of strabismus.Less than 20° vertical strabismus could be corrected by inferior rectus recession with 2.5° correction by each lmm recession.78.9%(15/19)of large vertical strabismus could be corrected well by inferior rectus recession of the affected eye.21.0% of them need myectomy of inferior rectus or recession of inferior rectus plus resection of superior rectus.The management of all large vertical deviation needs a suture fixation of eyeball.Conelusiorts The therapeutic effect of recession of inferior rectus on patients with thyroid-related myopathy was remarkably good in our hands.The most optimal time when surgery should be performed,the choice of procedure and some special attention in performing surgery were discussed in detail.