Endoscopic Orbital Decompression by Oculoplastic Surgeons for Proptosis in Thyroid Eye Disease

Abstract

The authors report the outcomes of a series of endonasal orbital decompression carried out by oculoplastic surgeons. Purpose: Orbital decompression is an established surgical treatment option for a range of orbital conditions. Traditionally, Ear, Nose and Throat surgeons have adopted the endoscopic route while ophthalmologists operate via an external approach. The authors report the outcomes of endonasal decompression performed by oculoplastic surgeons experienced in endonasal techniques. Methods: This was a retrospective case series of patients who underwent endoscopic orbital decompression for proptosis secondary to thyroid eye disease across 2 hospital sites between January 2011 and July 2018. Inclusion criteria were patients who had endoscopic decompression for proptosis in inactive thyroid eye disease or active disease without dysthyroid optic neuropathy. Information collected includes patient demographics, diagnosis, surgical details, preoperative and postoperative clinical findings (including, visual acuity, color vision, exophthalmometry readings, palpebral aperture, intraocular pressure, ocular motility, diplopia, and visual field), complications, and further treatment. Results: There were 70 cases of endoscopic decompression. The majority of patients had endoscopic medial and posterior medial wall/floor decompression (44.3%; 31/70 cases). Visual acuity remained stable in 98.6% (69/70). There was an average reduction in proptosis of 3.5 ± 1.2 mm (standard deviation [SD]) in the endoscopic medial wall only group, 3.9 ± 0.9 mm (SD) in endoscopic medial wall and posterior medial portion of the floor group, and 7.6 ± 2.1 mm (SD) in the 3-wall decompression group. Motility improved in 11.4% (8/70) and worsened in 2.9% (2/70). There were no significant intraoperative or postoperative complications associated with endoscopic surgery. Conclusions: Oculoplastic surgeons experienced in endonasal techniques can perform endoscopic orbital decompression with outcomes comparable to the literature.

Comparison of Transconjunctival and Transnasal approaches for orbital decompression: A randomized controlled trial

“…[26][27][28] Nowadays, to reduce the lateral wall decompression has noticeably attracted scholars' attention because of the low occurrence rate of postoperative diplopia and strabismus. [29] In Valerie et al's study, the removal of the medial and inferior walls provided a proptosis reduction of 3.9 mm, while the three-wall decompression reduced proptosis by 7.6 mm, [30] indicating that the removal of lateral wall had a great in uence on the value of proptosis reduction. In the present study, 16 of 22 patients in the transconjunctival group and 21 of 24 patients in the transnasal group experienced the removal of lateral wall (P = 0.276).…”

Endoscopic Orbital Decompression for Graves’ Orbitopathy – A Vietnam Study

“…[11][12][13][14] Results are variable and the case series by Juniat (2019) and Woods (2019) have shown that a mean reduction of 3.3 mm or more is possible with endoscopic two-wall orbital decompression. [15][16][17] The smaller reduction in the current study may be due to the low preoperative proptosis. In this study, the mean preoperative proptosis was 19.82 ± 2.84 mm, smaller than that in the previous studies.…”