|
NR. 2(II)/2005
|
|
|
|
|
|
|
|
|
Operacyjne leczenie
zeza i podwójnego widzenia w orbitopatii w przebiegu choroby
Gravesa-Basedowa
Surgical Treatment of the Strabismus and Diplopia in Orbitopathy
Due to the Graves-Basedow Disease
Ewa Filipowicz
Oddział Leczenia Zeza i Niedowidzenia Wojewódzkiego Szpitala
Okulistycznego w Krakowie Witkowicach
Ordynator: dr n. med. Ewa Wójcik |
|
|
|
|
|
|
|
| Summary: |
Ocular symptoms of the
ophthalmopathy and orbitopathy due to the Grave-Basedow
disease include eyelids retraction, changes in soft
tissues and in the anterior segment of the eye,
egzophthalmus, changes in extraocular muscles the most
often with strabismus and diplopia and changes in the
optic nerve. Due to the therapeutic management there are
two phases of the ophthalmopathy and orbitopathy –
active and inactive. Active phase of the disease is the
indication for surgical management of the strabismus and
diplopia. Disorders in motility and position of the
globes are caused by fibrosis including mostly inferior
rectus muscle, medial rectus muscle, rarely oblique
inferior and superior muscle. In orbitopathy there are
three types of strabismus: isolated vertical strabismus,
horizontal strabismus – the most often convergent,
horizontal strabismus with vertical deviation. Necessary
conditions for surgical treatment employment are: large
strabismus angle and permanent diplopia, which is
impossible to correct with other methods use,
stabilization of the strabismus angle value and diplopia
for 3 months, active phase of the disease absence,
permanent euthyreosis for 6 months. The most proper
moment for surgery performance is period prior to the
muscle fibrosis phase or the very beginning of this
phase. One of the most frequently performed surgeries on
extraocular muscles include procedures consisting in
reversing fibrous muscle or fibrous muscle reversion
with concomitant shortening its' homolateral antagonist.
Surgery range depends on strabismus angle volume before
surgery, intraoperative result of the passive motility
test or result of the active globe motility test. Very
good results of the surgical treatment i. e.
orthoposition, lack of diplopia while looking straight
ahead and down without compensatory head positioning,
obtains the most often in patients with vertical
strabismus, slightly rarely in patients with convergent
strabismus. The smallest favorable results of the
surgical treatment are noted in patients with horizontal
strabismus with vertical deviation. Postoperative
complications include: edema of lids and ocular
conjunctiva, lower lid retraction, anterior segment
ischemia and overcorrection. |
| |
|
| Key words: |
Grave's ophthalmopathy and
orbitopathy, strabismus, diplopia, extraocular muscle
surgery. |
|
|
|
|
|
|
|
|
