Objective: To evaluate the early efficacy and safety of transnasal endoscopic decompression in the annulus of zinn (AZ) region for refractory dysthyroid optic neuropathy (DON) and to preliminarily analyze the correlated factors of postoperative visual function outcome. Methods: From July 2021 to January 2023, 35 patients (56 eyes) with DON who received AZ area decompression in Peking University Third Hospital were included retrospectively, including 9 males (13 eyes) and 26 females (43 eyes), aging (52.2±12.0) years. Among them, 35 eyes underwent two-wall (medial and inferior) orbital decompression using an endonasal endoscopic approach, while 21 eyes received three-wall (medial, lateral, and inferior) orbital decompression through a combined approach. Key parameters such as best corrected visual acuity (BCVA), visual field (MD value), eyeball prominence, intraocular pressure, and complications were recorded. Postoperative data were collected one month after surgery. The statistical analysis was performed using paired t-test and Spearman correlation analysis. Results: Significant outcomes were observed post surgery in BCVA, visual field, intraocular pressure and proptosis (t value was 8.37, 6.17, 4.50, and 9.20, respectively, all P<0.001). The reduction in proptosis was statistically significant between the 2-wall and 3-wall orbital decompression groups (t=-2.82, P=0.007). Changes in BCVA, visual field, and intraocular pressure before and after surgery was greater in the 3-wall orbital decompression group compared to 2-wall orbital decompression group, although the difference was not statistically significant (all P>0.05). Change in postoperative visual acuity and visual field was significantly positively correlated with preoperative visual acuity and preoperative visual field (all P<0.001). Similarly, change in intraocular pressure and proptosis was positively correlated with preoperative intraocular pressure and preoperative protrusion (all P<0.001). Preoperative diplopia was reported in seven patients (20.0%), and two new cases (5.7%) were noted post-operation, which resolved within 3 months after surgery. Conclusions: Endoscopic endonasal decompression of the AZ area is a safe and effective surgical treatment for DON, with notable improvements in BCVA. Furthermore, three-orbital wall decompression seems to yield better outcomes in terms of eye retraction.
目的： 评估鼻内镜下总腱环（annulus of zinn，AZ）区域减压作为难治性甲状腺相关眼病视神经病变（dysthyroid optic neuropathy，DON）手术治疗方案的早期疗效及安全性，并初步分析术后视功能转归的影响因素。 方法： 回顾性纳入2021年7月至2023年1月于北京大学第三医院接受鼻内镜下AZ区域减压的DON患者35例（56眼），年龄（52.2±12.0）岁，男性9例（13眼），女性26例（43眼）。其中接受单纯经鼻内镜内、下壁（以下简称2壁）眶减压35眼，鼻内镜联合经眶入路深外壁减压的内、外和下壁（以下简称3壁）眶减压21眼，记录治疗前后的最佳矫正视力（best corrected visual acuity，BCVA）、视野（MD值）、眼球突出度（突眼度）、眼压等指标，同时记录不良反应及其发生率，以手术后1个月的复查结果作为治疗后数据。统计学分析采用配对t检验和Spearman相关分析法。 结果： 患者术后BCVA、视野、眼压及突眼度明显改善，手术前后相比，差异有统计学意义（t值分别为8.37、6.17、4.50和9.20，P值均<0.001）。3壁眶减压组突眼度变化差值大于2壁眶减压组，差异有统计学意义（t=-2.82，P=0.007）；BCVA、视野和眼压手术前后变化差值3壁眶减压组有大于2壁眶减压组的趋势，但差异无统计学意义（P值均>0.05）。术后视力差值和视野差值与术前视力、术前视野呈正相关（P值均<0.001）；术后眼压差值和突眼度差值与术前眼压、术前突眼度呈正相关（P值均<0.001）。术前复视患者7例（20.0%），术后新增复视患者2例（5.7%）且于术后3个月内恢复。 结论： 鼻内镜下AZ区域减压是安全、有效的治疗难治性DON的手术方式，BCVA改善明显。AZ区域减压结合联合入路3壁眶减压可更好地改善眼球突出度。.