Factors Predicting the Success of Combined Orbital Decompression and Strabismus Surgery in Thyroid-Associated Orbitopathy

Abstract

To evaluate the safety and efficacy of orbital decompression combined with strabismus surgery in thyroid-associated orbitopathy (TAO) and identify factors leading to surgical success. A retrospective comparative case series was conducted on 52 patients who were treated with combined orbital decompression and strabismus surgery. Outcome measurements included perioperative Hertel exophthalmometry and strabismus measurements. Surgical success was defined as binocular single vision (BSV) in the primary and reading positions within 5 prism diopters (PDs). As a result, the average reduction in proptosis was 3.23 mm, with a mean preoperative Hertel measurement of 22.64 mm. Forty-four patients (84.6%) achieved the success criterion and composed the success group. In addition to sex and underlying hyperthyroidism, symmetry of orbitopathy, interocular exophthalmos difference of more than 2 mm, predominant esotropia type, mixed type strabismus, baseline horizontal deviations, baseline vertical deviations, and combination with one-wall decompression surgery were significantly different between the success and failure groups. All complications were mild and temporary. Orbital decompression combined with strabismus surgery produced satisfactory outcomes in selected patients with efficacy and safety. Symmetry between the two eyes with relatively simple strabismus and proptosis ensured surgical success. With experienced surgeons, advanced techniques, and selected patients, this method can serve as an alternative treatment option to minimize the number of surgeries, medical costs and recovery period.

The Challenges and Therapeutic Prospects in Eye Disease

“…Steiert et al examined visual parameters dependent on the orbital muscle volume fraction in a surgically treated GO cohort and suggested that the orbital muscle volume factor should be addressed during treatment decisions, while early orbital decompression should be considered particularly in decreased vision with orbital muscle enlargement [ 8 ]. In a way that is different to the traditional staged GO management order (decompression and then muscle surgery or lid surgery), Hsieh et al suggested that orbital decompression combined with strabismus surgery by experienced surgeons can achieve satisfactory outcomes in selected patients, especially for those with symmetry of orbitopathy, relatively simple strabismus and mild proptosis [ 9 ]. Choi et al further supported the use of customized orbital decompression surgery combined with eyelid or strabismus surgery in mild to moderate GO patients, as it had favorable cosmetic results comparable to those achieved through stepwise techniques [ 10 ].…”