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

Abstract

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.

Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy

“…The benefits of associating bone and fat removal for optimal proptosis reduction are also outlined by the favorable results of our study. Similar outcomes using the combined technique are reported by other authors [19,20].…”

Current trends in the management of thyroid eye disease

“…An endoscopic medial wall approach is thought to allow good access to the middle and posterior intraconal fat for removal, resulting in more axial retrodisplacement of the globe [42]. A retrospective study of 90 orbits showed that intraoperative tailoring of surgical technique with addition of bony decompression, if needed, as based on intraoperative proptosis reduction, can be a helpful modification to obtain target endpoints of surgery [43].…”

Preoperative clinical features of reactivated of Graves’ orbitopathy after orbital decompression

“…Surgery was performed through a lower canthofornix and caruncle approach under general anesthesia, as previously reported. 20 Following septal incision, all postseptal medial, central, and lateral fat pads were excised. The retrobulbar inferolateral fat pocket, which has the greatest amount of fat, was dissected between the lateral and inferior rectus muscles, incising the tenon fascia towards the apex.…”