Orbital Decompression for Thyroid Eye Disease

Braun, Tara L.; Bhadkamkar, Mohin A.; Jubbal, Kevin T.; Weber, Adam C.; Marx, Douglas P.

doi:10.1055/s-0037-1598192

Cited by 25 publications

(29 citation statements)

References 32 publications

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“…In addition, there will be increase in the intraorbital pressure causing congestion and impedance of orbital venous outflow and restriction of extraocular motility leading to diplopia. Moreover, compressive optic neuropathy may develop in patients with severe forms of the disease 3, 4, 5, 6…”

Section: Pathogenesismentioning

confidence: 99%

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

Al-Sharif

Alsuhaibani

2017

Saudi Journal of Ophthalmology

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Orbital decompression is an effective and invaluable procedure for addressing some of the chronic manifestations of Graves' Ophthalmopathy (GO) such as exophthalmos and orbital congestion. Fat-removal orbital decompression (FROD) started to gain popularity after its introduction in the late 20th century. Among the therapeutic armamentarium of techniques and approaches available for orbital decompression, FROD has proven its efficacy and safety in addition to its ability to reduce proptosis in a relatively predictable manner. In addition, postoperative complications occurring after FROD are generally considered to be less frequent and less serious compared to bone-removal orbital decompression (BROD). Nevertheless, despite of FROD's high benefit-to-risk ratio, proper selection of patients based on meticulous preoperative assessment, including imaging, is of paramount importance to achieve optimal functional and aesthetic results. Although up till now there is still no consensus regarding the procedure of choice in GO patients, FROD is an important option to consider in this subset of patients.

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Section: Pathogenesismentioning

confidence: 99%

“…Immunosuppressive corticosteroids, oral or intravenous pulses, are generally considered the first line therapy to control active disease. Orbital radiation may also be used solely or as an adjunct with steroids in patients with mild to moderate active disease 5, 7, 8…”

Section: Treatmentmentioning

confidence: 99%

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

Al-Sharif

Alsuhaibani

2017

Saudi Journal of Ophthalmology

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“…In our study, the imaging technique of choice for patient evaluation was CT. A recent review [5] states that almost 96 % of surgeons are in favor of CT evaluation, while only 3% opt for MRI (magnetic resonance imaging). Braun et al [6] also advocate for the use of CT in the preoperative planning, claiming that the investigation can be useful in anticipating the amount of proptosis reduction that can be achieved surgically. In our study, CT images were carefully analyzed preoperatively for establishing the amount of proptosis, the symmetry, and the predominance of orbital fat or muscle volume growth.…”

Section: Discussionmentioning

confidence: 99%

“…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. Clauser et al [18] stated that an association of fat and osseous decompression is most appropriate for proptosis greater than 26 mm, in the presence of both adipose tissue and muscle volume expansion.…”

Section: Discussionmentioning

confidence: 99%

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

Costan

Ciocan-Pendefunda

Ciofu

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Aim The purpose of this study is to share our experience on the use of different orbital decompression techniques, as well as the principles followed for deciding the most case-appropriate procedure that ensured the most favorable outcomes. Methods We reviewed the Graves’ ophthalmopathy cases operated over the course of 14 years, regarding the presenting signs, the imaging evaluation, the degree of exophthalmos, the type of surgical orbital decompression performed, and the postoperative outcomes. Results All 42 patients identified presented with proptosis, with 92.8% cases of bilateral proptosis. The main addressing concern was functional in 54.8% cases and aesthetic in 45.2% patients. CT was used for the preoperative evaluation in all cases. In total, 81 orbits were operated. The orbital decompression surgery involved only the orbital fat in 7.4% of orbits and associated fat and bone decompression in the other 92.6% of orbits. The postoperative results were favorable in all cases regarding both appearance and function, with minimal postoperative complications. Conclusion The adequate selection of the most suitable procedure based on the characteristics of each case is the prerequisite for a successful surgery. We found that the association of fat and bone decompression of various extents is most permissive in tailoring the degree of decompression to the existing requirements.

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“…Various techniques and approaches for orbital decompression exist. Orbital decompression has been described as one-, two-, and three-wall bony decompressions with or without orbital fat removal, solely fatty decompression, and with or without the use of the endoscope [ 12 ]. However, there is no consensus on the most efficient intervention.…”

Section: Introductionmentioning

confidence: 99%

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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Orbital Decompression for Thyroid Eye Disease

Cited by 25 publications

References 32 publications

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

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

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

Strategies in Surgical Decompression for Thyroid Eye Disease

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