Transantral orbital decompression for Graves'disease

Abstract

Seventy-five patients with Graves' disease have been treated by transantral orbital decompression. In the first post-operative month the average reduction in proptosis was 3 mm. In the years following the operation this reduction increased to an average of 4.5 mm. In 32% of the patients without diplopia before surgery, the diplopia that developed afterwards did not disappear, 83% of them were successfully treated by extraocular muscle surgery. Seventy per cent of the patients experienced immediate post-operative improvement of visual acuity. Only three patients remained with anaesthesia of the infra-orbital nerve. A total of 65% of the patients found the operation procedure beneficial while 76% were satisfied with the ophthalmological result. We conclude, that transantral orbital decompression, though with moderate morbidity, gives good results in patients with the orbital complications of Graves' disease.

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

“…10,16 This does not support the assumption held by some authors that transconjunctival decompression may be less effective in the treatment of optic nerve compression. 5,27 It may, however, well be thatFin our studyFthe medial precaruncular extension of the transconjunctival incision added to the exposure of the medial wall.…”

“…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] …”

Results of transantral orbital decompression in patients with thyroid‐associated ophthalmopathy

“…Our rates of permanent hypesthesia are higher than has previously been reported after transantral orbital decompression (Warren et al 1989;Tjon et al 1994) but we believe this is due to a high answering rate to our questionnaire (95%) and a careful registration of the hypesthesia itself, differentiating between hypesthesia and the distress secondary to it, since several patients reported a subjective numbness but no distress from the numbness itself. In the majority of cases the hypesthesia was not considered a major problem.…”

Endoscopic orbital decompression for Graves’ ophthalmopathy

“…3,12 A recent review of 75 patients undergoing trans-antral decompression found that only 65 per cent of patients found the procedure bene cial. 15 Endoscopic orbital decompression was rst reported in 1990 with axial proptosis being reduced by a mean of 5.7.mm when combined with lateral orbitotomy and 4.7.mm when decompressed by an endoscopic approach alone. 7 As other surgeons have developed the technique, reported mean reductions in proptosis now range from 3.0 to 4.7.mm 1,5,7,[16][17][18][19][20][21] (Table I).…”