갑상샘눈병증 환자에서 안와감압수술 이후의 임상양상 및 경과

Clinical Characteristics and Treatment Courses of Patients with Thyroid-associated Orbitopathy after Orbital Decompression Surgery

Purpose: To report clinical findings in post-operative changes of proptosis, patient satisfaction, diplopia, extraocular muscle limitation after orbital wall decompression surgery in thyroid-associated orbitopathy (TAO) patients. Methods: The medical records of 63 patients and 111 eyes that underwent orbital wall decompression in a single medical center, between 2005 and 2018 were reviewed retrospectively. Demographic data such as mean age, sex, thyroid disease status, reasons/indications for performing orbital wall decompression were analyzed along with postoperative changes in exophthalmometry, extraocular movement limitation, extraocular muscle thickness, diplopia, and patient satisfaction. Results: Proptosis was reduced by 3.41 ± 1.74 mm at 1-2 months after surgery, and 4.72 ± 2.22 mm at 3 years after surgery, and proptosis reduction tended to improve when more orbital walls were decompressed. After orbital decompression, 29 patients (46%) required strabismus surgery while 26 patients (41%) required eyelid surgery. 35 patients (56%) reported to have no diplopia before and after surgery, while 27 (43%) patients had similar or aggravated diplopia. Patient satisfaction (thyroid eye disease quality of life questionnaire) significantly improved in all categories, 3 years after decompression surgery. Conclusions: Proptosis reduction tended to improve when more orbital walls were decompressed in TAO patients. Patients that received surgery in their active phase, due to optic neuropathy, showed better reduction in proptosis in the long term. Although not statistically significant, extraocular muscle thickness increased, and lateral extraocular movement limitation aggravated after decompression, which led to sequential strabismus surgery. Eyelid surgeries were also performed after decompression. Although long treatment periods and multiple surgeries make it difficult for ophthalmologists to treat TAO patients, the clinical courses reported in this study may be helpful guidelines to improve their quality of life.