Reduction of Diplopia Following Endoscopic Orbital Decompression: The Orbital Sling Technique

Abstract

The incidence of new-onset or worsened diplopia following endoscopic decompression was significantly lower for the orbital sling group compared with control subjects (0% vs. 29.2%, respectively [ =.038]). No patients in the orbital sling group developed new-onset diplopia following surgery. Of the eight patients with pre-existing diplopia from the orbitopathy, double vision improved in four patients (50%) and was unchanged in the remaining four patients (50%). The mean reduction in proptosis was comparable for the orbital sling and control groups (5.1 +/- 1.1 mm vs. 5.0 +/- 1.9 mm, respectively [ P=.98]). CONCLUSIONS The preservation of a fascial sling overlying the medial rectus muscle during endoscopic orbital decompression appears to reduce the incidence of postoperative diplopia, while still allowing for a satisfactory reduction in proptosis. This modification of the standard decompression technique should be considered for the treatment of patients with proptosis.

Efficacy and side effects of ‘swinging eyelid’ orbital decompression in Graves' orbitopathy: a proposal for standardized evaluation of diplopia

“…In three studies on transnasal decompression, the reported incidence of NOD ranged from 22 20 to 29% 18 before recalculation, and from 44 18 to 58% 16 after recalculation. After recalculation, a comparable high frequency of NOD was found in one study that predominantly contained patients with CON 16 and in two studies that predominantly contained patients with DGO.…”

“…After recalculation, a comparable high frequency of NOD was found in one study that predominantly contained patients with CON 16 and in two studies that predominantly contained patients with DGO. 18,20 In two studies on decompression by orbital fat removal, the reported (and recalculated) frequency of NOD ranged from 0 to 3%. 41,42 NOD and indication for surgery In only three studies, 4,24,37 in which both patients with DGO and those with CON were included, the authors had calculated the incidence of NOD according to the indication for surgery.…”

“…44 Although it was reported that limited opening of the periorbita may result in a lesser amount of retroplacement of the globe, 44 no difference in proptosis reduction was noted between patients who underwent transnasal orbital decompression using the so-called 'orbital sling' technique and those treated with nonmodified transnasal decompression. 18 Recalculation of data from studies on anterior approach three-wall orbital decompression, including translid, transconjunctival ('swinging eyelid'), and coronal techniques show relatively low NOD frequencies of 0 to 33% (Table 6). Although it was speculated that a 'balancing effect' of lateral and medial wall decompression may limit the frequency of NOD, 7,24,26,31,35,38 recent studies 25,30 failed to show a difference between translid or transconjunctival two-wall decompression and coronal three-wall decompression in that respect.…”

“…1 Transantral as well as transnasal orbital decompression have been reported to induce diplopia in up to 73% of patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] After translid, transconjunctival, transcaruncular, [21][22][23][24][25][26][27][28][29][30] and coronal orbital decompression, 25,[30][31][32][33] as well as after combinations of these techniques, [34][35][36][37][38][39][40] diplopia was observed less frequently, while orbital fat removal seems to carry the lowest risk of inducing diplopia. [41][42] Recently, we reported on a modified 'swinging eyelid' approach for two-or three-wall orbital decompression in 19 patients with GO.…”

“…9,25 Therefore, we propose a new scoring system, which we use to calculate the incidence of induced diplopia in our series and in previously published series. [3][4][5][6][7][8][9][10][11][12][13]16,18,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39] …”