PURPOSE To gauge the efficacy and safety of performing a one-stage endoscopic orbital decompression procedure combined with the intraoperative relaxed medial rectus muscle (MR) positioning technique as a means of treating esotropia associated with thyroid-associated ophthalmopathy (TAO). DESIGN Prospective, single-blind, randomized controlled trial. SETTING Eye Hospital of Wenzhou Medical University. METHODS 38 TAO patients fulfilled the study requirements. The patients in Group A (n=19; mean age 52.32 ± 9.90 years; 12 males, 7 females) underwent a one-stage surgical procedure, whereas the patients in Group B (n=19; mean age 52.53 ± 8.49 years; 9 males, 10 females) underwent staged surgery. Preoperative and postoperative best-corrected visual acuity (BCVA), visual field mean deviation (MD), Hertel exophthalmometry, intraocular pressure (IOP), deviation, ocular motility, and diplopia were compared between these two groups. RESULTS Of the patients in Group A, 8 (42.11%) underwent unilateral orbital decompression and 11 underwent bilateral decompression, while all 19 patients in Group B underwent bilateral decompression. Both groups exhibited significant improvements in postoperative BCVA (Group A 0.09 ± 0.15 logMAR, Group B 0.04 ± 0.08 logMAR), MD of visual field (Group A -2.73 ± 3.36 dB, Group B -1.82 ± 3.75 dB), proptosis (Group A 16.23 ± 2.58mm, Group B 17.04 ± 2.70mm), and IOP (Group A 16.23 ± 4.49mmHg, Group B 17.24 ± 4.14mmHg) when comparing postoperative values to preoperative levels, while there were no significant differences between these groups. In each group, 8 patients (42.11%) underwent surgical procedures targeting one single MR, whereas the remaining 11 in each group underwent surgery on two MRs. The respective primary motor and sensory success rates in Group A were 68.40% (13/19) and 78.95% (15/19), whereas those in Group B were 73.70% (14/19) and 84.21% (16/19), with no significant differences between these groups in terms of postoperative residual strabismus, stereoscopic vision improvements, or success rates. CONCLUSION These results demonstrate that a one-stage surgical procedure can simultaneously alleviate proptosis and diplopia while achieving outcomes comparable to those achieved through staged surgery. This treatment strategy can thus provide patients with greater therapeutic convenience, decreasing the overall number of surgical procedures and their attendant risks.

中文翻译：

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一期眼眶减压联合术中肌肉松弛治疗 TAO：一项随机对照试验。


目的 评估进行一期内窥镜眼眶减压手术联合术中松弛内直肌 （MR） 定位技术作为治疗甲状腺相关眼病 （TAO） 相关内斜视的手段的有效性和安全性。设计 前瞻性、单盲、随机对照试验。温州医科大学 SETTING 眼科医院.方法 38 例 TAO 患者满足研究要求。A 组患者 （n=19;平均年龄 52.32 ± 9.90 岁;12 名男性，7 名女性）接受了一期手术，而 B 组患者 （n=19;平均年龄 52.53 ± 8.49 岁;9 名男性，10 名女性）接受了分期手术。比较两组术前和术后最佳矫正视力 （BCVA） 、视野平均偏差 （MD） 、Hertel 眼球测量法、眼压 （IOP） 、偏差、眼球运动和复视。结果 A 组患者 8 例 （42.11%） 行单侧眼眶减压，11 例行双侧减压，B 组 19 例患者均行双侧减压。当将术后值与术前水平进行比较时，两组术后 BCVA（A 组 0.09 ± 0.15 logMAR，B 组 0.04 ± 0.08 logMAR）、视野 MD（A 组 -2.73 ± 3.36 dB，B 组 -1.82 ± 3.75 dB）、眼球突出（A 组 16.23 ± 2.58 mm，B 组 17.04 ± 2.70 mm）和 IOP（A 组 16.23 ± 4.49 mmHg，B 组 17.24 ± 4.14 mmHg）均显著改善， 而这些组之间没有显著差异。每组 8 例患者 （42.11%） 接受了针对 1 例 MR 的外科手术，而每组其余 11 例患者接受了 2 例 MR 手术。 A 组原发性运动和感觉成功率分别为 68.40% （13/19） 和 78.95% （15/19），而 B 组分别为 73.70% （14/19） 和 84.21% （16/19），两组在术后残余斜视、立体视觉改善或成功率方面差异无统计学意义。结论 这些结果表明，一期外科手术可以同时缓解眼球突出和复视，同时获得与分期手术相当的结果。因此，这种治疗策略可以为患者提供更大的治疗便利性，减少外科手术的总数及其伴随的风险。