Radiographic Analysis of Extraocular Muscle Volumetric Changes in Thyroid-Related Orbitopathy Following Orbital Decompression

Hu, Wanda D.; Annunziata, Christine C.; Chokthaweesak, Weerawan; Korn, Bobby S.; Levi, Leah; Granet, David B.; Kikkawa, Don O.

doi:10.1097/iop.0b013e3181b80fae

Cited by 34 publications

(11 citation statements)

References 29 publications

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“…A significant increase in the medial rectus muscle after orbital decompression surgery was recently reported by Hu et al 9. In our study, we found that patients who had undergone orbital scanning in the early postoperative period exhibited an increase in the extraocular muscle volume, whereas those who had undergone scanning 20 weeks after surgery exhibited a decrease in the extraocular muscle volume.…”

Section: Discussionsupporting

confidence: 82%

Effect of orbital bony decompression for Graves' orbitopathy on the volume of extraocular muscles

Alsuhaibani

Carter

Policeni

et al. 2011

British Journal of Ophthalmology

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Section: Discussionsupporting

confidence: 82%

Effect of orbital bony decompression for Graves' orbitopathy on the volume of extraocular muscles

Alsuhaibani

Carter

Policeni

et al. 2011

British Journal of Ophthalmology

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“…The possible causes include reactivation of thyroid orbitopathy, continued activity at the time of prior decompression surgery, or progressive or reactive enlargement of the extraocular muscles following decompression. 37 …”

Section: Discussionmentioning

confidence: 99%

Compressive Optic Neuropathy and Repeat Orbital Decompression

Kauh

Gupta

Douglas

et al. 2015

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose To characterize the presenting characteristics, pre-operative clinical activity score (CAS), surgical approach, and visual outcomes in patients with thyroid eye disease undergoing repeat orbital decompression for recurrent or recalcitrant compressive optic neuropathy. Methods The medical records of patients with recurrent or recalcitrant compressive optic neuropathy (CON) undergoing repeat orbital decompressions were retrospectively reviewed. The primary outcome measures included pre- and post-operative Humphrey visual field mean deviation, visual acuity measured in logarithm of the minimal angle of resolution, color vision measured by Ishihara plates, and presence of relative afferent pupillary defect. Details of the surgical procedure and each patient’s CAS at presentation were also recorded. Results Six patients, 9 orbits, with a mean pre-operative CAS of 3.8 were included in this review. The mean time between initial decompression and presentation to our center for recurrent or persistent CON symptoms was 8.6 years (range, 1–15 years). At presentation, the average HVF mean deviation was −16.5 (standard deviation (SD): 8.8), improving to −3.8 (2.4) post-operatively with a mean of 9.3 months follow-up (mean improvement of 75%). Pre-operative visual acuity was 0.34 (0.23) LogMAR, improving to 0.05 (0.10) logMAR with a mean follow up of 10.4 months. Pre- to post-operative comparisons of clinical measures all showed statistically significant improvement (p<0.05). Eight eyes presented with decreased visual acuity (any VA < 20/20), 4 with decreased color vision (any color vision < 11), and 1 with a relative afferent pupillary defect and all of these patients demonstrated improvement following repeat orbital decompression. Conclusions In patients with thyroid eye disease, symptoms of recurrent compressive optic neuropathy occurred up to 15 years following initial orbital decompression underscoring the smoldering, progressive nature of the disease. Repeat decompression which focused on the orbital apex resulted in visual improvement in all 6 patients. Despite clinical evidence of compressive optic neuropathy, the mean CAS of these patients at presentation was only 3.8, highlighting the importance of close monitoring of patients with thyroid eye disease following decompression regardless of the external manifestations of disease activity.

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“…In a previous study, a signi cant increase in medial rectus muscle volume was observed postoperatively in patients with TED who underwent orbital decompression surgery [12]. The mean volume of the inferior rectus muscle (IR) also increased after orbital decompression surgery.…”

Section: Introductionmentioning

confidence: 87%

Minimization of Extraocular Muscle Damage in Thyroid Eye Disease Patients Following Surgery Based on Computerized Biomechanics

Jeong

Lee

Ryu

et al. 2021

Preprint

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Background To evaluate the risk of general orbital decompression in patients with thyroid eye disease (TED).Methods In this study, we replicated the behavior of intraorbital tissue in patients with TED based on finite element analysis. The orbit and intraorbital tissues of TED patient who underwent orbital decompression were modeled as finite element models. The stress was examined at a specific location of the removed orbital wall of a patient with TED who had undergone orbital decompression, and its variation was investigated and analyzed as a function of the shape and dimension (to be removed).Results In orbital decompression surgery which removes the orbital wall in a rectangular shape, the stress at the orbital wall decreased as the width and depth of the removed orbital wall increased. In addition, the stress of the non-chamfered model (a form of general orbital decompression) was higher than that of the chamfered model. Especially, in the case of orbital decompression, it can be seen that the chamfered model compared to the non-chamfered model have the stress reduction rate from 11.08% to 97.88%.Conclusions It is inferred that if orbital decompression surgery considering the chamfered model is performed on an actual TED patient, it is expected that the damage to the extraocular muscle caused by the removed orbital wall will be reduced.

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Radiographic Analysis of Extraocular Muscle Volumetric Changes in Thyroid-Related Orbitopathy Following Orbital Decompression

Abstract: There is a significant increase in medial rectus muscle volume postoperatively in orbits undergoing orbital decompression for TRO despite lacking clinical evidence of disease reactivation.

Cited by 34 publications

References 29 publications

Effect of orbital bony decompression for Graves' orbitopathy on the volume of extraocular muscles

Effect of orbital bony decompression for Graves' orbitopathy on the volume of extraocular muscles

Compressive Optic Neuropathy and Repeat Orbital Decompression

Minimization of Extraocular Muscle Damage in Thyroid Eye Disease Patients Following Surgery Based on Computerized Biomechanics

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