Graded orbital decompression based on severity of proptosis

Kikkawa, Don O.; Pornpanich, Kanograt; Cruz, Romeo C; Levi, Leah; Granet, David B.

doi:10.1016/s0161-6420(02)01068-0

Cited by 94 publications

(67 citation statements)

References 25 publications

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“…22 In 16 studies on transconjunctival, transcaruncular, and translid decompression, the reported incidence of NOD ranged from 0 25 to 33%. 31 In one of these studies, 28 the reported incidence of NOD was 9% vs a recalculated value of 25%. In five other studies, a combined transnasal and translid/transconjunctival approach was used, with a reported incidence of NOD ranging from 0 34,35 to 12%.…”

Section: Other Side Effects and Complicationsmentioning

confidence: 99%

“…1 Transantral as well as transnasal orbital decompression have been reported to induce diplopia in up to 73% of patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] After translid, transconjunctival, transcaruncular, [21][22][23][24][25][26][27][28][29][30] and coronal orbital decompression, 25,[30][31][32][33] as well as after combinations of these techniques, [34][35][36][37][38][39][40] diplopia was observed less frequently, while orbital fat removal seems to carry the lowest risk of inducing diplopia. [41][42] Recently, we reported on a modified 'swinging eyelid' approach for two-or three-wall orbital decompression in 19 patients with GO.…”

Section: Introductionmentioning

confidence: 99%

“…9,25 Therefore, we propose a new scoring system, which we use to calculate the incidence of induced diplopia in our series and in previously published series. [3][4][5][6][7][8][9][10][11][12][13]16,18,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39] …”

Section: Introductionmentioning

confidence: 99%

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Efficacy and side effects of ‘swinging eyelid’ orbital decompression in Graves' orbitopathy: a proposal for standardized evaluation of diplopia

Paridaens

Lie

Grootendorst

et al. 2005

Eye

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Objectives To evaluate the efficacy and side effects of 'swinging eyelid' orbital decompression in patients with Graves' orbitopathy (GO). To calculate the incidence of postoperative new-onset diplopia (NOD) using a newly proposed scoring system for diplopia. Methods We reviewed the clinical data on proptosis, visual acuity, and diplopia in 104 consecutive patients (198 orbits) with GO, who underwent orbital decompression. A combined lateral canthal and inferior fornix incision ('swinging eyelid' approach) was used for removal of the medial wall, the orbital floor and, if indicated, the lateral wall. Indications for surgery were disfiguring/ congestive GO (DGO) in 79 patients (149 orbits) and compressive optic neuropathy (CON) in 25 patients (49 orbits). Diplopia was scored according to four grades. In both groups, the incidence of new-onset (continuous) diplopia (NOD), deterioration of diplopia (DOD), and improvement of diplopia (IOD) were calculated, using strictly defined criteria. Our data on NOD were compared to those from other series, after recalculation according to our criteria. Results The mean proptosis reduction was 4.6 mm (range 0-9.5 mm) after three-wall decompression (95 patients, 180 orbits) vs 3.1 mm (range 0-7 mm) after two-wall decompression (nine patients, 18 orbits). The visual acuity improved in 98% of the patients with CON. In patients with DGO, NOD occurred in 14%. In patients with CON, NOD was not observed, but DOD occurred in 41%. Our data compare favourably to the reported incidence of NOD after either transantral or transnasal decompression. Conclusions 'Swinging eyelid' orbital decompression is efficacious for proptosis reduction as well as for optic nerve decompression. A scoring system for standardized evaluation of diplopia is proposed.

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Section: Other Side Effects and Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and side effects of ‘swinging eyelid’ orbital decompression in Graves' orbitopathy: a proposal for standardized evaluation of diplopia

Paridaens

Lie

Grootendorst

et al. 2005

Eye

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show abstract

“…Retrobulbar fat excision leads to fewer motility complications than bony decompression [28,112,116,120,121]. Fat is removed inferolaterally, inferomedially, and/or superomedially.…”

Section: Orbital Decompressionmentioning

confidence: 99%

“…This posterior fat is identified by its whitish color, fibrous texture, and apical direction and by the absence of skin movement when tugged upon. Per orbit, 3 to 8 mL can be removed [28,112,116,120]. Removal of 1 mL of fat results in 1 mm of correction [122].…”

Section: Orbital Decompressionmentioning

confidence: 99%