Surgical treatment for malignant exophthalmos of endocrine origin

Abstract

Endocrine exophthalmos is a poorly understood disease process thought to be related to a dysfunction of the thyroid-pituitary axis. Initial therapy for symptomatic endocrine exophthalmos is medical. Failure to respond to medical management is heralded by progressive exophthalmos, exposure keratitis, and decreasing visual acuity. The pathophysiologic processes involved and an historical review of the various surgical procedures used are discussed. The results of 28 patients surgically decompressed by a transantral transethmoid approach are presented. Preservation or improvement in visual acuities were observed in all but one patient. Diplopia was generally not improved and may be worsened in some patients.

Transantral orbital decompression for Graves'disease

“…This reduction is comparable to that reported by Calcaterra & T h~m p s o n ,~ Hanabury et a/. : DeSanto,8 Ogura & Thawley: Gorman,I3 Shorr, Neuhaus & Bayliss, 14 Hurwitz & Birt" and McCord.16 Despite our observation that orbital herniation was less impressive in the group of patients with previous radiotherapy (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) months before surgery), the ultimate reduction of proptosis did not differ from the results in the group without radiotherapy. A possible explanation might be that a maximum of I year between radiotherapy and surgery was too short to develop fibrosis of the retrobulbar fat.…”

Endoscopic orbital decompression for dysthyroid eye disease

“…Nevertheless, the reduction of proptosis by the endoscopic approach is comparable to the transantral route, probably because the limited orbital floor decompression is offset by a good decompression of the medial wall (DeSanto, 1980;Warren et al, 1989;Kennedy, 1990;Metson, 1994;Sang et al, 1994). In our opinion, it is essential to aim for maximum medial wall decompression and avoid excessive orbital floor decompression which increases the risk of infraorbital nerve injury, post-operative diplopia and recurrent maxillary sinusitis (Hansbury et al, 1984;Bough et al, 1994). Kennedy et al (1990) described the presence of a thick bony orbital floor on pre-operative CT scan as a contra-indication to endoscopic decompression and advocated the transantral approach for these cases.…”

Geschwülste der Augenhöhlen im Material der Laryngologischen Klinik in Krakau

“…Diese Komplikationen können beim Prä-parieren von Geschwülsten auftreten, die mit der hinteren Wand des Auges verwachsen sind. Wenn man solche Geschwülste mobilisiert, muss man die Geschwulstwand sehr sorgfältig vom Augapfel abpräparieren; es empfiehlt Składzień /Modrzejewski/Olszewski/Reroń / Tomik/Strȩk sich, dies unter mikroskopischer Kontrolle zu tun [8,10,[12][13][14][15][16]. Die mit der Krönleinschen Methode durchgeführte Operation ermöglicht es, ein Mikroskop sowie sehr feine Instrumente zu verwenden.…”

“…[3,6,8,11,13,19,20] sind der Meinung, dass es besser ist, diese Veränderungen auf dem medialen Wege zu entfernen.…”

“…Gegenwärtig kann man die verschiedenen Zugangswege der Orbitotomie in anteriore und laterale, einfache und osteale unterteilen. Man muss Knochen mobilisieren, wenn man zum Gewebe hinter dem Augapfel vordringen will [6][7][8].…”