摘要
目的 :探讨甲状腺相关眼病上睑退缩的治疗方法。方法 :回顾分析临床资料完整的 90例 1 2 3眼甲状腺相关眼病上睑退缩的治疗效果。治疗方法包括保守观察、全身和局部糖皮质激素治疗、局部肉毒杆菌毒素注射和手术治疗等。治疗后平均随访 1 .4年。结果 :用全身和局部糖皮质激素治疗 34例 4 9眼中 ,上睑退缩完全消失 4例 6眼 ,明显改善1 3例 2 0眼 ,无效 1 7例 2 3眼 ;局部肉毒杆菌毒素注射 2 0例2 6眼中 ,上睑退缩完全消失 8例 9眼 ,明显改善 9例 1 1眼 ,无效 3例 6眼 ,持续时间 6w至 2年 ,注射后并发上睑下垂 4例 5眼 ;提上睑肌延长术 1 1例 1 5眼中 ,术后上睑退缩完全消失 7例 1 0眼 ,明显改善 2例 3眼 ,复发 1例 1眼 ,轻度过矫1例 1眼 ;上睑退缩伴患眼下斜视 1 5例 1 5眼 ,行患眼下直肌后退术 ,其中术后上睑退缩完全消失 1 4例 1 4眼 ,明显改善 1例 1眼 ;1 0例 1 8眼未作任何治疗 ,经平均 2年随访观察发现2例 4眼上睑退缩完全消失 ,1例 2眼有明显改善。结论 :甲状腺相关眼病上睑退缩宜采用综合治疗措施。发病初期或活动期病例用全身和局部糖皮质激素和局部注射肉毒杆菌毒素治疗效果好 ,静止期或保守治疗效果不好的患者宜行提上睑肌延长术治疗 ,伴有下斜视的患者行斜视矫正术可同时矫正斜视与上睑退缩。
Objective:To report the therapeutic effects on upper eyelid retraction in patients with thyroid associated ophthalmopathy.Methods:The therapeutic outcomes in ninety cases of upper eyelid retraction with a diagnosis of thyroid associated ophthalmopathy was analyzed retrospectively. There were 37 males and 53 females. The mean age was 47.3 (range 32.4～63.0 years). According to each patient's situation,the patients were treated by observation,systemic and/or local corticosteroid,botulinum toxin injection and surgical correction,with a mean follow up of 1.4 years.Results:An ideal or acceptable result was obtained in 17 of 34 patients (50%)(26 of 49 eyes) with systemic and/or local corticosteroid therapy and in 17 of 20 patients (85%)(20 of 26 eyes) with botulinum toxin injection. The degree of lid lowering varied among patients and lasted between 6 weeks and 2 years in the group that received botulinum toxin injections and 4 cases (5 eyes) had complications from ptosis after injections that lasted from 1 to 3 weeks. Nine of 11 patients (13 of 15 eyes) who underwent a surgical procedure had ideal or acceptable results. One patient (1 eye) was slightly overcorrected and one (1 eye) undercorrected (recurred). Ideal or acceptable results were obtained in 15 of 15 patients (100%) (15 of 15 eyes) with both upper eyelid retraction and hypotropia after inferior rectus recession. Three of 10 patients (6 of 18 eyes) also had good results with no treatment at all.Conclusion:Several therapeutic methods can be used in the treatment of upper eyelid retraction in patients with thyroid associated ophthalmopathy. Patients in the early or active stage should be treated with systemic or local corticosteroid and local botulinum toxin injection. Surgery is required to correct eyelid retraction in patients in the quiescent stage of orbitopathy. In patients with both upper eyelid retraction and hypotropia,strabismus surgery not only can correct hypotropia but also reduce upper eyelid retraction.
出处
《眼视光学杂志》
2005年第1期50-52,56,共4页
Chinese Journal of Optometry & Ophthalmology
基金
广东省自然科学基金资助项目 ( 2 0 0 1 0 748)。
关键词
上睑退缩
治疗
甲状腺相关眼病
局部
肉毒杆菌毒素
糖皮质激素
全身
和局
结论
保守
thyroid associated ophthalmopathy/drug therapy
corticosteroid/therapeutic use
botulinum toxin/therapeutic use
ocularplastic surgery
upper eyelid retraction
