Minimally Invasive Orbital Decompression for Graves' Ophthalmopathy

Abstract

We reviewed a 7-year experience at a tertiary-care, academic medical center with balanced, minimally invasive decompression for Graves' ophthalmopathy, in an effort to define the goals, risks, and outcomes of surgical intervention. Endoscopic medial decompression was performed in 26 patients; 23 underwent lateral decompression as well, and 13 also had inferior decompression. Septoplasty, turbinate reduction, and orbital rim augmentation were performed as needed. The indications for surgery were threat to vision (n = 10) and proptosis with a desire to return to the predisease state (rehabilitative, n = 16). The exophthalmos improved by a mean of 4.4 mm (p < .001). All patients who had surgery for threatened vision had improved vision after the operation. There were 3 patients with new-onset postoperative diplopia, 2 of whom underwent strabismus surgery. There was 1 case of postoperative sinusitis, which resolved with oral antibiotics and nasal decongestion, and 1 case of transient ulnar neuropathy. There were no other intraoperative or postoperative complications. Modern methods of orbital decompression provide a minimally invasive, effective, and relatively safe approach to the treatment of Graves' ophthalmopathy.

Thyroid‐associated orbitopathy (TAO) treated by lateral orbital decompression

“…The results of this surgery are highly similar to those reported previously for other techniques (Rodahl et al 1999; Paridaens et al 2000; Danesh‐Meyer et al 2001; Linnet et al 2002; Graham et al 2003; Vaseghi et al 2003). However, it is notable that the major complications reported with other surgical techniques, such as diplopia and infraorbital nerve anaesthesia (Goldberg et al 2000; Kikkawa et al 2002; Kacker et al 2003) were not found in our material.…”

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

“…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%. 40 In three of these, data were insufficient for recalculation, in the other two the reported value did not differ from the recalculated value. In five studies on coronal orbital decompression, the reported incidence of NOD ranged from 3 33 to 33% 31 before recalculation, and from 8 33 to 50% 32 after recalculation.…”

“…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.…”

Efficacy and safety of orbital decompression in treatment of thyroid‐associated ophthalmopathy: long‐term follow‐up of 78 patients

“…It is destructive in nature with a risk of many complications such as vision loss, motility disturbance of extraocular muscles, cerebrospinal fluid leakage, obstructive sinus disease, eyelid malposition, infraorbital nerve disturbance, and dacryostenosis. Although series published so far suggest that decompression surgery benefits TAO patients at least in the short term, 6–12 studies of its long‐term effects with a reasonable number of patients are scarce 13–16 …”