Long-term outcomes of orbital fat decompression in Graves’ orbitopathy

Cheng, Anny M. S.; Wei, Yi‐Hsuan; Tighe, Sean; Sheha, Hosam; Liao, Shu‐Lang

doi:10.1136/bjophthalmol-2016-309888

Cited by 28 publications

(28 citation statements)

References 26 publications

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“…[ 19 ] In another recently published large series conducted in Taiwan involving a total of 1604 GO eyes, all patients received a 4.5 mL orbital fat resection with significantly correlated improvements of proptosis with an average 4.4 mm reduction from baseline (Hertel value: 21.1 mm). [ 20 ] According to by Cheng et al, 85.1% of eyes achieved complete success with improvement and no recurrence, 13.7% had only partial success with new onset or persistent diplopia, and 1.2% failed to achieve surgical outcome. No complication was reported after these fat-removal surgeries.…”

Section: Discussionmentioning

confidence: 99%

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Application of lateral tarsoconjunctival flap to correct ocular complications of Madelung's disease

et al. 2018

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Rationale:Madelung's disease is a specific type of benign symmetric lipomatosis, which is characterized by overgrowing fat distributed at the neck and shoulder. This excessive fat accumulation may occur in different regions, including vital organs, such as the larynx, trachea, or the orbits. Surgery is usually performed to correct the esthetic or functional concern of the affected area. There are only few case reports mentioned about the orbital involvement of this disease. This study aimed to describe a case of Madelung's disease with ocular complications and the successful treatment using tarsoconjunctival flap.Patient concerns:A 90-year-old obese male presented with decreased visual acuity accompanied with severe band form punctate epithelial erosions and ciliary injections in both eyes. Exophthalmos and ectropion of the lower eyelids were observed.Diagnoses:Orbital computed tomography revealed a rare entity of Madelung's disease with significant massive deposits of lipomas located symmetrically around the orbit and neck region.Interventions:Bilateral lateral tarsoconjunctival flaps with lateral tarsal strip procedures were performed to correct the lower eyelid ectropion-related exposure keratopathy.Outcomes:The patient obtained improved visual acuity, intact and clear corneal surfaces, and perfect lower eyelid positions over both eyes.Lessons:Madelung's disease is a rare condition. There are few reports to describe its ocular complications, due to lipoma overgrowing in the orbit. We shared our successful experience to correct ocular complications using tarsoconjunctival flap technique.

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Section: Discussionmentioning

confidence: 99%

“…Interestingly, both series reported patients that underwent additional surgeries for eyelid retraction after FROD. In Cheng's series, [ 20 ] 20.9% of patients underwent eyelid retraction surgery within 6 months, while an average of 2.5 lid surgeries were carried out for each patient in Richter's series. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Application of lateral tarsoconjunctival flap to correct ocular complications of Madelung's disease

et al. 2018

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“…Orbital bony decompression may or may not combine fat removal. For solely fatty decompression, the efficacy of proptosis reduction has been reported as 3.5-5.9 mm [ 51 – 54 ] in the short-/intermediate-term or 4.2 ± 1.4 mm in the long-term follow-up [ 3 ].…”

Section: A Practical Algorithm For Surgical Decompression In Disfimentioning

confidence: 99%

“…The 3-wall decompression, with the addition of one-wall decompression, led to a higher incidence of new diplopia of 57% [ 50 ]. The risk of newly onset diplopia in lateral and fatty decompressions tends to be low in the range of 0-6% [ 28 , 57 , 58 ] and 3.3% [ 3 ], respectively.…”

Section: A Practical Algorithm For Surgical Decompression In Disfimentioning

confidence: 99%

“…Progress has been made in the understanding of the pathogenesis of TED. Orbital fibroblast is recognized as a prime target [ 2 ]; the recent finding that extraocular muscle (EOM) can be vitally involved is also important [ 3 ]. Cytokines play important roles in orbital inflammation during the active phase [ 4 ], with subsequent tissue remodeling and fibrosis during the inactive phase [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Strategies in Surgical Decompression for Thyroid Eye Disease

Cheng

Wei

Liao

2020

Oxidative Medicine and Cellular Longevity

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Surgical management of thyroid eye disease- (TED-) associated morbidity has been plagued by the complex interplay of different operative techniques. Orbital decompression is the well-recognized procedure for disfiguring exophthalmos and dysthyroid optic neuropathy (DON). There are numerous published techniques described for the removal of the orbital bone, fat, or a combination. The diverse studies are noncomparative as they include different indications, stages of disease, and methods of evaluation. Thus, it is difficult to conclude the most efficient decompression technique. To obtain effective and predictable results, it is therefore important to propose a logical and acceptable clinical guideline to customize patient treatment. Herein, we developed an algorithm based on the presence of DON, preoperative existing diplopia, and severity of proptosis which were defined by patient’s disabling symptoms together with a set of ocular signs reflecting visual function or cosmesis. More specifically, we aimed to assess the minimal but effective surgical technique with acceptable potential complications to achieve therapeutic efficacy. Transcaruncular or inferomedial decompressions are indicated in restoring optic nerve function in patients with DON associated with mild or moderate to severe proptosis, respectively. Inferomedial or fatty decompressions are effective to treat patients with existing diplopia associated with mild or moderate to severe proptosis, respectively. Fatty or balanced decompressions can improve disfiguring exophthalmos in patients without existing diplopia associated with mild to moderate or severe proptosis, respectively. Inferomedial or 3-wall decompressions are preferred to address facial rehabilitation in patients associated with very severe proptosis but without preoperative diplopia.

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