中文摘要：

目的探讨甲状腺相关眼病（TAO）放射治疗的适应证和临床效果。方法选择1992至2004年在四川大学华西医院肿瘤科放射治疗室行眼眶照射、资料较齐全的23例TAO患者，其中9例是浸润性突眼、14例是压迫性视神经病变，均为糖皮质激素治疗不敏感、不能接受糖皮质激素治疗者，或者因较严重的糖尿病、高血压等不能做眼眶减压或不愿意做手术的活动期且病程短的TAO患者。采用直线加速器和Donaldson眼眶外照射法，照射野大小为4cm×5cm，放射总剂量为20GY，治疗分10次，每次2GY。放射治疗期间其中11例炎性反应较重的患者同时口服泼尼松。全部患者放射治疗前后均行外眼照像和眼眶CT检查。结果14例压迫性视神经病变，放射治疗前矫正视力0．04～0．2，放射治疗后矫正视力0．1～0．8，CT检查显示肿大的眼外肌缩小，眼外肌缩小的程度与视力提高的程度成正相关。9例浸润性突眼，放射治疗前眼部炎性反应明显，放射和口服泼尼松治疗后眼睑、结膜肿胀显著减退，眶压降低，眼睑能闭合，暴露性角膜炎痊愈，眼球活动受限好转，眼球突出度降低1～3mm。随访1～3年，3例患者又出现视力减退，4例眼眶炎性反应复发，2例眼睑仍部分闭合不全。结论活动性难治的TAO患者采用放射治疗效果较好，对于眼眶炎性反应严重的患者可加用糖皮质激素治疗。

英文摘要：

Objective To observe indication and effectiveness of radiation therapy （RT） in the treatment of the patients with thyroid-associated ophthalmopathy （TAO）. Methods 23 patients of TAO who received RT in Sichuan University were collected from 1992 to 2004. Among those patients, 9 cases of infiltrative exophthalmos and 14 cases of compressive optic neuropathy were ineffectively with glucocorticoid treatment or could not treated with glucocorticoid ,or could not perform orbital decompression due to severe diabetic melitus or hypertesion, or feared to receive the operation, all of patients were active ophthalmopathy and with short duration. Outer orbital radiation was applied using linear accelerator with Donaldson＇s method, radiation treatment fields was 4 cm× 5 cm , exposure engery was 2 GY fractions with total of 20 GY. In 11 cases with severe inflammation prednisone was admistrated during radiotherapy. Photos and CT scan were taken for each patient before and after RT. Results Visual acuity（VA）of the patients was improved from before RT 0. 04-0. 2 to after RT 0. 1-0. 8 in 14 cases of compressive optic neuropathy. Extraocular muscle of patients dicreased in size confirmed by CT scan. VA improvement was correlated with the degree of extraocular muscle dicreased in size. Eyelid and conjunctive swelling, eyelid incompletely closure, exposure keratitis, limitation of motion and proptosis were improved after RT in 9 patients with infiltrative exophthalmos. Following up the patients for 1-3 years, it was found that VA decreased in 3 cases and inflammation recurred in 4 cases, eyelids could not closed in 2 cases after RT. Conclusions RT could be used in severe, active cases of TAO. If there is severe inflammation , steroids could be combined with RT therapy.