Cheng, A.M., Wei, Y.H., Tighe, S., Sheha, H., Liao, S.L.
期刊名称：The British journal of ophthalmology
预后 眼病 眼眶
摘要：目的：旨在探讨眶脂减压术治疗Graves眼病（GO）的远期临床疗效。方法：回顾性分析2003年至2014年期间接受了眼眶脂肪减压术的845例对称性（1518只眼），不对称性（86只眼）突眼患者。评估基线，术后6个月和每年的Hertel值变化。记录和分析需要额外手术的复发性突眼，复视和其他并发症。手术预后如果突眼减少，没有复发，复视改善或没有复视则定义为完全成功。如果突眼减少且无复发但有持续或新发复视则认为部分成功。如果突眼复发，无论有无复视均考虑失败。结果：随访37.9±24.4个月后，1365只眼（85.1％）获得成功，219只眼（13.7％）取得部分成功，20只眼（1.2％）失败。新发复视和二次减压发生率分别为3.3％和0.6％。总突出减少4.1±1.3 mm，贯穿中长期（5 - 10年）随访。眶脂去除量（4.5±1.1 mL）在长期Hertel变化中起着重要作用。结论：眼眶脂肪减压术在纠正损毁面容性突眼方面具有远期疗效，且并发症发生率低，无需二次减压手术。这也与生活质量显着改善相关。
PURPOSE:To evaluate the long-term clinical efficacy of orbital fat decompression in treating proptosis in Graves' ophthalmopathy (GO).METHODS:Retrospective review of 1604 eyes of 845 patients with symmetric (1518 eyes) and asymmetric (86 eyes) proptosis who received orbital fat decompression between 2003 and 2014. Changes in Hertel values were evaluated at baseline, 6 months postoperatively and yearly thereafter. Recurrence of proptosis, diplopia and other complications that required additional surgeries were documented and analysed. The surgical outcome was defined as complete success if there was proptosis reduction with no recurrence and improved or no diplopia. Partial success was considered if there was proptosis reduction without recurrence yet persistent or new-onset diplopia. Failure was considered if there was recurrence of proptosis regardless of diplopia. The patient's quality of life was also evaluated as a long-term outcome.RESULTS:After follow-up for 37.9±24.4 months, 1365 eyes (85.1%) achieved complete success, 219 eyes (13.7%) achieved partial success and 20 eyes (1.2%) had failure. Newly onset diplopia and secondary decompression occurrence rate remained low at 3.3% and 0.6%, respectively. The total proptosis reduction was 4.1±1.3 mm, which was consistent all through the intermediate and long-term (5-10 years) follow-up. The amount of orbital fat removal (4.5±1.1 mL) played a significant role in the long-term Hertel change. Importantly, the overall quality of life increased significantly for GO patients after undergoing orbital fat decompression.CONCLUSIONS:Orbital fat decompression has a long-term efficacy in correcting disfiguring proptosis with a low complication rate and without the need of secondary decompression procedures. This was also associated with a significant improvement in quality of life.