Minimally invasive surgery for thyroid eye disease

Abstract

Thyroid eye disease (TED) can affect the eye in myriad ways: proptosis, strabismus, eyelid retraction, optic neuropathy, soft tissue changes around the eye and an unstable ocular surface. TED consists of two phases: active, and inactive. The active phase of TED is limited to a period of 12–18 months and is mainly managed medically with immunosuppression. The residual structural changes due to the resultant fibrosis are usually addressed with surgery, the mainstay of which is orbital decompression. These surgeries are performed during the inactive phase. The surgical rehabilitation of TED has evolved over the years: not only the surgical techniques, but also the concepts, and the surgical tools available. The indications for decompression surgery have also expanded in the recent past. This article discusses the technological and conceptual advances of minimally invasive surgery for TED that decrease complications and speed up recovery. Current surgical techniques offer predictable, consistent results with better esthetics.

Fat-removal orbital decompression for thyroid associated orbitopathy: The right procedure for the right patient

“…The techniques of BROD described in the scientific literature are abundant; yet, the extent of bony removal and approach (incision) varies depending on the patient’s clinical presentation and the surgeon’s experience 5, 7. Decompressive techniques usually target the medial, lateral and inferior walls whereas the orbital roof should be avoided due to the potential serious complications 5, 14…”

“…1). As a general rule, orbital fat removal from the infrotemporal part of the orbit will result in a 2 mm reduction in proptosis postoperatively compared to 2 mm for each wall in bone decompression 14 . The superionasal fat pad can also be excised through a lid crease incision to further decrease proptosis by 0.5–1 mm 18…”

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

“…Naik et al [17] argued that each orbital wall removed leads to approximately 2-mm proptosis reduction. Braun et al [6] states that removing orbital fat increases the reduction of exophthalmos by an additional 2-4 mm, particularly when orbital fat expansion is predominant.…”

Minimally Invasive Methods of Surgical Treatment of Endocrine Ophthalmopathy

“…В настоящее время для осуществления резекции стенок глазницы и удаления интраорбитального жира применяют коронарный кожный доступ, трансназаль-ный эндоскопический доступ, доступ по верхнему веку, трансконъюнктивальный доступ через нижний свод глаза, транскарункулярный доступ [2,3]. Каждый из на-званных хирургических доступов к стенкам глазницы имеет определенные преимущества и недостатки, что рождает множество дискуссий среди хирургов, занима-ющихся хирургическим лечением ЭО [2,3,4,5,6].…”

“…Каждый из на-званных хирургических доступов к стенкам глазницы имеет определенные преимущества и недостатки, что рождает множество дискуссий среди хирургов, занима-ющихся хирургическим лечением ЭО [2,3,4,5,6].…”