Oscillopsia After Isolated Lateral Wall Decompression Versus Balanced or 3-Wall Decompression

Abstract

Purpose: To assess the incidence of postoperative masticatory oscillopsia after orbital decompression, comparing results between isolated lateral wall and balanced or 3-wall orbital decompression. Methods: An observational retrospective study was performed, involving 161 consecutive patients who underwent orbital decompression between 2008 and 2018. Patients’ clinical data were registered, and archives were revised for data compilation. Patients were divided into 2 groups according to the type of surgery: “lateral” group included patients who underwent isolated lateral wall decompression and “lateral plus” group involved patients with balanced or 3-wall decompression. Exclusion criteria were secondary decompressions, those not including lateral wall and asymmetrical surgeries, so analysis was performed among 131 remaining patients. Oscillopsia was self-reported and was registered as present or not. Diplopia was evaluated according to Paridaens grading system. Results: Statistical analysis among the 131 patients with lateral wall decompression (isolated or in combination) was performed. Seven patients referred oscillopsia, 5 among “lateral” group, while 2 reported oscillopsia on “lateral plus” group (p = 0.001). The authors found no differences on new-onset or worsening of diplopia between groups (p = 1) Conclusions: Oscillopsia was significantly higher after isolated lateral wall decompression than after balanced or 3-wall decompression, while no differences were found between groups according to diplopia status. Transmission of temporal muscle contraction to the orbit seems to be the cause of the oscillopsia. The authors postulate that the absence of orbital floor or medial wall may act as a dampener for the temporalis muscle contractions, allowing the orbital contents to be expanded through them, and avoiding oscillopsia.

Oscillopsia following orbitotomy for intracranial tumor resection

“…Masticatory oscillopsia has been reported in up to a third of patients following orbital decompression resulting from transmission of temporalis contractions to the globe through the resultant orbital defect. [ 6 , 17 ] Patients who undergo traumatic orbital wall fracture may develop orbital meningoencephalocele and experience ocular pulsation. [ 7 ] Particularly salient to the cases described above, Mettu et al .…”

Descompressão lateral profunda na orbitopatia de Graves: deformação do músculo reto lateral, efeitos translacionais e rotacionais oculares

“…Na abordagem "rim-off", remove-se todo o rebordo lateral, da sutura frontozigomática ao arco zigomático e a cirurgia pode ser realizada por cima, medial ou lateralmente ao trígono do esfenoide (Cruz et al, 2021a). Ao fim do procedimento, esse rebordo pode ser reposicionado Rosenstock, 1983;Shore;Carvajal, Westfall, 1992;Kikkawa et al, 2002;Bailey;Tower;Dailey, 2005;Elner, 2010;Kakizaki et al, 2011b;Sagiv et al, 2016;Sweeney et al, 2017;Oeverhaus et al, 2019;Stähr et al, 2019;Porrúa-Tubio et al, 2021) ou não (Long;Ellis, 1966;Trokel;Cooper, 1979;Piest;Newman, 1989;Fichter et al, 2004; Cho; Há várias incisões que podem ser empregadas nesses acessos (Figura 7). A primeira incisão empregada por Julius Dollinger era oblíqua e se estendia da porção lateral do supercílio ao tragus (Dollinger, 1911).…”

“…A prega palpebral superior, cosmeticamente incisada nas blefaroplastias, é um acesso utilizado para DLP desde 1999, quando Harris a descreveu para a realização de orbitotomias laterais (Harris;Logani, 1999;Ben Simon et al, 2004;Chang;Piva, 2008;Rocchi et al, 2012;Fichter;Choi;Lee, 2016;Hernandez-Garcia et al, 2017;Cubuk;Konuk;Unal, 2018;Bengoa-Gonzalez et al, 2019;Porrúa-Tubio et al, 2021). Apesar dessa longa evolução em busca de cicatrizes estéticas, ainda são encontradas descrições atuais de DLP por acessos extensos ou que deixam marca evidente, como no acesso coronal (Goldberg et al, 2000;Baldeschi et al, 2005;Sellari-Franceschini et al, 2005;Spalthoff et al, 2018), na incisão em supercílio (Sellari-Franceschini et al, 2005) e na linha capilar temporal (Gong et al, 2018).…”

“…Dentre os múltiplos efeitos da DLP, já foram bem documentados, a deformação do músculo reto lateral e consequente mudança no equilíbrio oculomotor são os menos conhecidos. Na literatura sobre a DLP há ampla discussão sobre o efeito enoftálmico da cirurgia e as complicações diversas (Matton, 1991;Kerivan, 1998;Goldberg et al, 2000;Kikkawa et al, 2002;Ben Simon et al, 2004Liao et al, 2006;Chang;Piva, 2008;Kakizaki et al, 2011b;Mehta;Durrani, 2011;Fayers et al, 2013;Fichter;Krentz;Guthoff, 2013;Fichter;Sagiv et al, 2016;Siah;Patel;Malhotra, 2016;Kang;Kakizaki, 2016;Ueland;Haugen;Rødahl, 2016;Goldberg, 2018;Jefferis et al, 2018;Ramesh et al, 2018;Bengoa-Gonzalez et al, 2019;Zhang et al, 2019;Cruz et al, 2021a;Porrúa-Tubio et al, 2021).…”

“…Os estudos demonstraram baixa incidência de diplopia desencadeada pela DLP, variando entre 2,4% e 18%. Em sua maioria, os autores descrevem apenas a variação da queixa da diplopia quanto à manutenção, piora ou melhora desse sintoma após a cirurgia (Baldeschi et al, 2005;Liao et al, 2006;Chang;Piva, 2008;Schaaf et al, 2010;Mehta;Durrani, 2011;Fichter;Ueland;Haugen;Rødahl, 2016;Gupta;Goldberg, 2017;Jefferis et al, 2018;Bengoa-Gonzalez et al, 2019;Horn;Porrúa-Tubio et al, 2021). Alguns autores realizaram mensurações superficiais sobre a oculomotricidade, sem caracterizar o tipo de estrabismo e/ou quantificar os desvios horizontais e verticais de acordo com as versões oculares (Goldberg et al, 2000;Ben Simon et al, 2006).…”