【摘要】 目的：甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)所致限制性斜视患者多出现复视、眼球运动受限，严重影响患者的日常生活与工作，对此类斜视在原发病情稳定后多采取眼外肌手术治疗。本研究旨在对比分析针对TAO所致限制性斜视的受累眼外肌实施3种直肌减弱术的疗效，并总结手术体会。方法：回顾性分析2017年3月至2023年8月于中南大学湘雅医院眼科中心就诊的TAO所致限制性斜视患者50例(68眼)，针对引起眼位偏斜、眼球运动障碍的主要目标眼外肌分别行单纯直肌徙后术(徙后组)、直肌Y型劈开徙后术(Y劈组)及改良直肌Y型劈开徙后术(改良组)。术后观察斜视度、眼位、眼球运动、双眼视功能、有无复视及代偿头位等，并且至少有1次回访(≥6周)。结果：50例患者中，男24例，女26例；受累下直肌40条，上直肌28条；年龄为28～77岁，手术时年龄为(52.9±9.5)岁；病程为6个月至30年，术后随访时间为1.5～43.0个月。3组术前与术后第1天、术前与术后随访终点的斜视度差异均有统计学意义(均P<0.001)。徙后组术后第1天斜视度较术前减小23.52棱镜度(prism diopter,PD)，术后随访终点斜视度较术前减小23.33 PD;Y劈组术后第1天、术后随访终点斜视度较术前分别减小27.50、28.58PD；改良组术后第1天、术后随访终点斜视度较术前分别减小35.67、37.00 PD。50例患者中，术前45例(90.0%)有复视，术后随访终点时有32例(71.1%)第一眼位和阅读眼位复视消失，差异有统计学意义(χ~2=42.04,P<0.001)。所有患者术后随访终点时眼球运动、双眼视功能均较术前明显改善，代偿头位均消失。结论：根据TAO患者眼外肌运动限制的不同程度，可采用单纯直肌徙后术、直肌Y型劈开徙后术及改良直肌Y型劈开徙后术，3种术式均能够解除或改善肌肉限制，提升眼球运动的能力并扩大眼球运动的范围，有效消除眼位偏斜和复视，提高患者的视功能及生活质量。更多还原

【Abstract】 Objective:Patients with restrictive strabismus caused by thyroid-associated ophthalmopathy(TAO) often experience diplopia and restricted eye movements,which significantly affect patient’s daily life and work.For such strabismus cases,extraocular muscle surgery is commonly performed once the primary condition stabilizes.This study aims to compare and analyze the effectiveness of 3 rectus muscle weakening procedures on the affected extraocular muscles in TAO-induced restrictive strabismus,and to summarize surgical experiences.Methods:A retrospective analysis was conducted on 50 patients (68 eyes) with TAO-induced restrictive strabismus who were treated at the Eye Center,Xiangya Hospital,Central South University,between March 2017 and August 2023.The main target extraocular muscles causing ocular deviation and movement restrictions were subjected to either simple rectus recession (served as a recession group),rectus Y-split recession (served as a Y-split group),or modified rectus Y-split recession (served as a modified group).Postoperative observations included strabismus angle,ocular alignment,eye movement,binocular visual function,presence of diplopia,and compensatory head posture,with at least one follow-up visit (≥6 weeks).Results:Among the enrolled 50 patients,there were 24 males and 26 females;the affected muscles included 40 inferior rectus muscles and 28 superior rectus muscles.The patients’ages ranged from 28 to 77 years,with a surgical age of (52.9±9.5) years.The disease duration ranged from 6 months to 30 years,with postoperative follow-up periods ranging from 1.5 to 43.0 months.Significant differences in the strabismus angle were observed between preoperative and postoperative day 1,and between preoperative and final followup in all 3 groups (all P<0.001).In the recession group,the strabismus angle decreased by23.52 prism diopters (PD) on postoperative day 1 and by 23.33 PD at the final follow-up.In the Y-split group,the strabismus angle decreased by 27.50 PD on the postoperative day 1and by 28.58 PD at the final follow-up.In the modified group,the strabismus angle decreased by 35.67 PD on the postoperative day 1 and by 37.00 PD at the final follow-up.Among the 50 patients,45 (90.0%) had preoperative diplopia,and 32 (71.1%) experienced resolution of primary and reading position diplopia at the final follow-up (χ~2=42.04,P<0.001).At the final follow-up,all patients showed significant improvement in eye movement and binocular visual function,with the elimination of compensatory head posture.Conclusion:Depending on the degree of extraocular muscle movement restriction in TAOpatients,simple muscle recession,Y-split recession,and modified Y-split recession can be employed.These procedures can effectively relieve or improve muscle restrictions,enhance eye movement capabilities and range,eliminate ocular deviations and diplopia,and improve the visual function and quality of life for patients.更多还原