Proptosis Reduction by Clinical vs Radiological Modalities and Medial vs Inferomedial Approaches

Thapa, Suman; Gupta, Ashok; Gupta, Amod; Gupta, V.; Dutta, Pinaki; Virk, Ramandeep Singh

doi:10.1001/jamaoto.2014.3659

Cited by 16 publications

(4 citation statements)

References 28 publications

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“…The measurement of exophthalmos by Hertel exophthalmometry before and after surgery is reliable. Proptosis measurements by Hertel exophthalmometry vs. computed tomography are comparable end equally effective [39]. We achieved an average of 4.9 mm of proptosis reduction, which is very similar to that achieved by other studies using DLW-PRS decompression [5, 20].…”

Section: Discussionsupporting

confidence: 80%

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

Bengoa-González

Galindo‐Ferreiro

Mencía‐Gutiérrez

et al. 2019

Journal of Ophthalmology

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Purpose To describe the results of thyroid-related orbitopathy (TRO) treated by ultrasonic deep lateral wall bony decompression with partial rim sparing (DLW-PRS). Methods A review was carried out, from January 2015 to September 2017, of all patients treated with ultrasonic DLW-PRS decompression using a SONOPET® (Stryker, Kalamazoo, MI, USA) ultrasonic aspirator, using a lateral, small triangle flap incision for access. The primary outcome was the change in proptosis (measured by the difference in Hertel exophthalmometry measurements). Other secondary outcomes were changes in visual acuity (VA) (using Snellen scale, decimal fraction), presence of lagophthalmos, eyelid retraction (measured by upper eyelid margin distance to the corneal reflex (MRD1) and lower eyelid margin distance to the corneal reflex (MRD2), and presence of exposure keratopathy). Results A total of 58 orbital decompressions in 35 patients were reviewed, with 23 patients (65.7%) having bilateral decompressions. There was a female preponderance with 26 patients (74.2%), and the mean age ± standard deviation was 52.6 ± 13.9 years. Mean proptosis was 24.51 ± 1.76 mm preoperatively, reduced to 19.61 ± 1.27 mm in final follow-up. The mean reduction was 4.9 ± 1.54 mm. VA improved from 0.8 ± 0.14 to 0.9 ± 0.12, p=0.039. 5 of 13 patients (38.4%) with preoperative diplopia reported improvement or complete resolution after surgery. MRD1 was reduced from 5.25 ± 0.88 mm to 4.49 ± 0.7 mm. MRD2 was also reduced from 6.3 ± 0.88 mm to 5.0 ± 0.17 mm. Presence of lagophthalmos was reduced from 35 eyes (60.3%) to five (8.6%); the presence of epiphora was also reduced from 20 patients (57.1%) to 3 (8.5%) following decompression. Complications of the surgery included zygomatic hypoaesthesia in 14 (40%) patients in the early postoperative period and chewing alterations in 10 (28.5%) of the patients. All of these complications were resolved at the 6-month follow-up visit. We noted no surgical complications such as ocular or soft tissue damage, infection, inflammation, or visual loss. Conclusions The SONOPET® ultrasonic bone curette can be used safely and effectively for DLW orbital decompression surgery. The main benefits were good visualization and handling of tissues and speed and ease of use of the equipment. This trial is registered with ClinicalTrials.gov identifier: NCT04025034.

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Section: Discussionsupporting

confidence: 80%

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

Bengoa-González

Galindo‐Ferreiro

Mencía‐Gutiérrez

et al. 2019

Journal of Ophthalmology

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“…A 3D vector can give a more comprehensive and intuitive view of the globe position. In previous reports, the mean values of 2D CT exophthalmos ranged from 21.2 mm to 22.5 mm in TED [1, 3, 21]; in our study, the mean value was 19.5 mm. The mean distance between the nasion and the pupillary center was 33.8 mm in TED [8], and the mean distance between the corneal apex and the MS plane was 32.2 in our study.…”

Section: Discussionsupporting

confidence: 47%

A Novel Three-Dimensional Vector Analysis of Axial Globe Position in Thyroid Eye Disease

Guo

Qian

Yuan

et al. 2017

Journal of Ophthalmology

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Purpose. To define a three-dimensional (3D) vector method to describe the axial globe position in thyroid eye disease (TED). Methods. CT data from 59 patients with TED were collected and 3D images were reconstructed. A reference coordinate system was established, and the coordinates of the corneal apex and the eyeball center were calculated to obtain the globe vector ECtrue→. The measurement reliability was evaluated. The parameters of ECtrue→ were analyzed and compared with the results of two-dimensional (2D) CT measurement, Hertel exophthalmometry, and strabismus tests. Results. The reliability of ECtrue→ measurement was excellent. The difference between ECtrue→ and 2D CT measurement was significant (p = 0.003), and ECtrue→ was more consistent with Hertel exophthalmometry than with 2D CT measurement (p < 0.001). There was no significant difference between ECtrue→ and Hirschberg test, and a strong correlation was found between ECtrue→ and synoptophore test. When one eye had a larger deviation angle than its fellow, its corneal apex shifted in the corresponding direction, but the shift of the eyeball center was not significant. The parameters of ECtrue→ were almost perfectly consistent with the geometrical equation. Conclusions. The establishment of a 3D globe vector is feasible and reliable, and it could provide more information in the axial globe position.

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“…18 Single medial wall removal leads to 1.66 mm while combined medial wall and medial orbital floor to 3.0 mm proptosis regression. In another study by Thapa (2015), medial wall removal also leads to only 1.8 mm regression while this outcome has been found much more significant in groups with two wall (medial and floor) removal at 4.8 mm. 19 Many patients with Graves' compressive neuropathy do not suffer from significant proptosis and, as such, may not warrant extensive wall decompression.…”

Section: Discussionmentioning

confidence: 86%

“…In another study by Thapa (2015), medial wall removal also leads to only 1.8 mm regression while this outcome has been found much more significant in groups with two wall (medial and floor) removal at 4.8 mm. 19 Many patients with Graves' compressive neuropathy do not suffer from significant proptosis and, as such, may not warrant extensive wall decompression. 20 Risks relating to excessive bone removal have been reported such as nerve damage, cerebrospinal fluid leakage, sinusitis and meningitis.…”

Section: Discussionmentioning

confidence: 86%

Endoscopic Orbital Decompression for Graves’ Orbitopathy – A Vietnam Study

Pham¹,

Nguyen²,

Quoc³

et al. 2021

OPTH

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Proptosis Reduction by Clinical vs Radiological Modalities and Medial vs Inferomedial Approaches

Cited by 16 publications

References 28 publications

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

A Novel Three-Dimensional Vector Analysis of Axial Globe Position in Thyroid Eye Disease

Endoscopic Orbital Decompression for Graves’ Orbitopathy – A Vietnam Study

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