Effect of orbital bony decompression for Graves' orbitopathy on the volume of extraocular muscles

Alsuhaibani, Adel H.; Carter, Keith D.; Policeni, Bruno; Nerad, Jeffrey A.

doi:10.1136/bjo.2010.188946

Cited by 24 publications

(13 citation statements)

References 18 publications

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“…20 As orbital radiation has been shown to modestly improve extraocular motility impairment, perhaps it can also lessen extraocular muscle swelling after decompression surgery, and as a result, lead to greater proptosis reduction. 15,21 Further studies are needed, as a Type I statistical error with this result is possible given the small sample size and the contradictory reports from literature.…”

Section: Discussionmentioning

confidence: 99%

Thyroid-Related Orbital Decompression Surgery: A Multivariate Analysis of Risk Factors and Outcomes

Niziol

Musch³

et al. 2017

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose Despite the number of publications on orbital decompression surgery for thyroid eye disease (TED), there are few comparative studies and most studies are underpowered. The goal of our study is to use multivariable analysis to identify independent patient and disease-related predictors of response to decompression surgery and of need for secondary decompressions. Methods We retrospectively reviewed all patients who underwent transorbital thyroid-related orbital decompression surgery at the Kellogg Eye Center of the University of Michigan between 1999 and 2014. Demographic, medical, and surgical covariates were collected. Decompression techniques included medial, lateral, and balanced decompressions, with or without orbital fat removal. Main outcomes included proptosis reduction and secondary decompressions, both analyzed at the orbital level. Univariate and multivariable analyses (with adjustment for inter-orbit correlation) were conducted to determine predictors of our outcomes of interest. Results Mean proptosis reduction was 3.8 ± 2.4 mm (mean ± standard deviation, N = 420 orbits). The secondary decompression rate was 13.8% (82/594). On multivariable mixed linear regression, larger preoperative proptosis (P < 0.0001), balanced decompression (P = 0.0002), TED duration < 4 years (P = 0.0093), and history of orbital radiation (P = 0.0111) were all predictive of greater proptosis reduction. On multivariable survival modeling, factors associated with increased hazard for secondary decompression include younger age (P = 0.0434), larger preoperative proptosis (P = 0.0001), unilateral decompression (P = 0.0272), preoperative steroid treatment (P = 0.0200), and normal thyroid function (P = 0.0148). Factors associated with decreased hazard include adjunctive fat decompression (P = 0.0004), balanced decompression (vs lateral, P = 0.0039), and African-American ethnicity (P = 0.0076). Conclusions Despite a diverse study cohort, we have identified factors associated with clinically relevant outcomes of decompression surgery for TED, including proptosis reduction and incidence of secondary decompression. Randomized controlled trials of different treatment algorithms for thyroid eye disease are needed to devise optimized guidelines for individualizing surgical care.

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Section: Discussionmentioning

confidence: 99%

Thyroid-Related Orbital Decompression Surgery: A Multivariate Analysis of Risk Factors and Outcomes

Niziol

Musch³

et al. 2017

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…The amount of proptosis reduction has been reported to be associated with the number of walls removed [6], the number and size of cuts made in the periorbita [22], and the type of preoperative proptosis [23]. However, because many complex factors influence the amount of proptosis reduction, it is difficult to predict postoperative outcomes of decompression [11,18,23-25]. To date, thyroid orbital surgeons have developed their own surgical procedures to best predict favorable surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy

Lee

Jang

Lee

et al. 2014

Korean J Ophthalmol

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PurposeTo investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings.MethodsThis is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved.ResultsFour types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 ± 2.8 mm) was reduced significantly at six months postoperatively (16.1 ± 2.3 mm). Proptosis significantly decreased with a mean of 4.3 ± 1.7 mm, and the reduction was greatest (5.1 ± 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy.ConclusionsGraded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis.

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“…Метод имеет как преимущества, так и недо-статки. К преимуществам следует отнести малую инвазивность, внутренний (эндоназальный) подход к орбите, что исключает разрезы кожи и последую-щие рубцовые изменения и обеспечивает выражен-ный регресс экзофтальма до 6 мм [3][4][5][6][7]. К недостат-кам относят высокий процент развития послеопера-ционной диплопии и косоглазия, которые встреча-ются с частотой до 40% случаев [8][9][10][11].…”

Section: обоснованиеunclassified

Aspects of endocrine ophthalmopathy surgical treatment by ENT specialist

Кочетков

Александрович²

2017

Clin Exp Thyroid

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Актуальность. Лечение эндокринной офтальмопатии является одной из чрезвычайно актуальных на сегодняшний день мультидисциплинарных проблем. Хирургическая помощь пациентам с эндокринной офтальмопатией недостаточна именно вследствие недостаточного взаимодействия офтальмологов, эндокринологов и оториноларингологов. Возможности использования эндоназальной эндоскопической хирургии в смежных анатомических областях чрезвычай-но актуальны в настоящее время. И приоритетной задачей оториноларингологов на сегодняшний день является изучение и разработка техники трансназальных, трансэтмоидальных, транссфеноидальных эндоскопических хирургических вме-шательств на структурах основания черепа и орбиты с целью минимизации инвазивности и повышения эффективности лечения ряда патологий, в том числе эндокринной офтальмопатии. Цель: оценить возможности хирургического лечения эндокринной офтальмопатии -трансэтмоидальной декомпрессии орбиты в отношении коррекции экзофтальма. Методы. В исследование были включены 64 пациента с эндокринной офтальмопатией при неэффективности медика-ментозного лечения, хирургическое лечение которых было проведено с 2006 по 2016 г. Прооперировано 90 орбит. Пациентам выполнялась трансэтмоидальная декомпрессия орбиты. Результаты. У всех пациентов в послеоперационном периоде отмечена стойкая положительная динамика, выражавшаяся в уменьшении экзофтальма и улучшении качества жизни в связи с исчезновением косметического дефекта, однако у всех пациентов мы наблюдали разной степени выраженности транзиторную или стойкую послеоперационную диплопию. Ни у кого из пациентов не отмечено орбитальных инфекционных осложнений или других клинически значимых инфек-ций полости носа и околоносовых пазух. Заключение. В представленном нами исследовании продемонстрирована высокая клиническая эффективность транс-этмоидальной декомпрессии орбиты в отношении регресса экзофтальма. Экзофтальм в среднем уменьшился у всех пациентов на 5,1 мм, а уровень послеоперационной диплопии составил менее чем 20% случаев. Клю че вые сло ва: хирургическое лечение эндокринной офтальмопатии, трансэтмоидальная декомпрессия орбиты, болезнь Грейвса.Background. Endocrine ophthalmopathy is a complex pathology in endocrinology and ophthalmology. It is multidisciplinary question, located at the junction of endocrinology and ophthalmology. Currently, the treatment of endocrine ophthalmopathy there are not many surgical approaches which differ in their effectiveness and safety. One of the most popular methods is transethmoid orbit decompression to the removal of the medial wall of the orbit and medial part of the orbital bottom. In addition, we can say unequivocally that this method slows down the progression of the disease, thereby improving visual acuity and quality of life. Aim: to assess the possibilities of endocrine ophthalmopathy surgical treatment -transethmoidal orbital decompression, according to reduce of exophthalmos. Methods. 64 patients with endocrine ophthalmopathy were included in the study with ineffective drug treatment, the surgical treatment of ...

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Effect of orbital bony decompression for Graves' orbitopathy on the volume of extraocular muscles

Abstract: The change in the volume of the MRM may partly explain the variability in the proptosis reduction following orbital decompression.

Cited by 24 publications

References 18 publications

Thyroid-Related Orbital Decompression Surgery: A Multivariate Analysis of Risk Factors and Outcomes

Thyroid-Related Orbital Decompression Surgery: A Multivariate Analysis of Risk Factors and Outcomes

Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy

Aspects of endocrine ophthalmopathy surgical treatment by ENT specialist

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