目的 评估内窥镜下经筛径路眶内壁减压（endoscopic transethmoidal orbital wall decompression， ETMOWD）联合脂肪减压（fat orbital decompression， FROD）术对甲状腺相关眼病（thyroid-associated ophthalmopathy， TAO）限制性斜视的影响效果。 方法 回顾性系列病例研究，选取2021年12月至2024年8月确诊为TAO的病例，按照是否行眶减压术，分成眶减压组（OD组）和非眶减压组（NOD组），比较两组之间围手术期的一般资料，斜视类型、眼球运动限制程度、眼肌后徙量及手术效果，并对OD组评估ETMOWD联合脂肪减压术式对斜视的影响。手术成功的定义为复视消失，术后斜视度≤ 5 PD。 结果 共计65 例纳入分析，其中OD组40例、NOD组25例，所有患者的甲状腺指标均在正常范围内，活动性评分均≤ 3分，处于静止期内，两组间的一般资料及术前斜视类型，包括水平和垂直斜视度差异无统计学意义（P > 0.05），而OD组眼球运动限制分级、手术次数、手术总肌肉数、水平肌肉数量以及水平肌肉后徙效应量明显高于NOD组，术后所有患者的眼球运动限制程度及复视情况均有明显缓解，ODG组治愈率为70%，NOD组治愈率为72%。并且，OD组经眶减压手术影响，眼压由术前的（19.43 ± 3.9） mmHg降至术后的（15.05 ± 2.2） mmHg（P < 0.001），而水平斜视度与垂直斜视度在术后均有所增加。 结论 与NOD相比，OD组斜视手术的复杂性增加，包括斜视程度、手术次数、总肌肉条数、水平肌条数及水平肌后徙效应量，ETMOWD联合脂肪减压术对水平肌的影响更为显著，但两种治疗方案的长期手术效果相似。

Objective To assess the efficacy of endoscopic transethmoidal orbital wall decompression （ETMOWD） in conjunction with fat removal orbital decompression （FROD） on restrictive strabismus in patients with thyroid?associated ophthalmopathy （TAO）. Methods A retrospective case series study was conducted involving patients diagnosed with TAO at our hospital from December 2021 to August 2024. Patients were divided into two groups： the orbital decompression group （OD group） and the non?orbital decompression group （NOD group）， based on whether they underwent orbital decompression surgery. The study compared perioperative data， types of strabismus， degree of ocular motility limitation， extent of posterior migration of ocular muscles， and postoperative outcomes between the two groups. Additionally， the effects of ETMOWD combined with FROD on strabismus were evaluated by analyzing changes in relevant indices before and after surgery in the OD group. Results A total of 65 participants were included in the analysis， with 40 in the OD group group and 25 in the NOD group. There was no statistically significant difference in baseline characteristics between the two groups. Preoperative strabismus types， including horizontal and vertical strabismus， did not differ significantly between the OD and NOD groups （P > 0.05）. However， the mean preoperative restriction grade of eye movement was significantly higher in the OD group compared to the NOD group. Additionally， the number of surgeries， mean total operated muscles， and number of horizontal muscles were all significantly higher in the OD group than in the NOD group （all P < 0.05）， with a notably different effect on horizontal muscle migration between the two groups. The degree of restriction of eye movement and diplopia improved significantly in all patients， with cure rates of 70% in the OD group and 72% in the NOD group. Furthermore， the OD group underwent ETMOWD combined with FROD orbital decompression surgery， which resulted in a decrease in intraocular pressure （IOP） from （19.43 ± 3.9） mmHg preoperatively to （15.05 ± 2.2 mmHg postoperatively （P < 0.001）. Both horizontal and vertical strabismus increased after surgery. Conclusions Our results demonstrated that， compared with the NOD group， the OD group exhibited increased complexity in strabismus surgery， as evidenced by a higher number of operations， total muscle strips， horizontal muscle strips， and greater migratory effect size of the horizontal muscles. The combination of ETMOWD and FROD effectively reduced exophthalmos， with a more pronounced effect on the medial rectus muscle compared to the vertical muscles. However， the long?term outcomes between the two groups were similar.