Transcaruncular approach to the medial orbit and orbital apex

Shorr, Norman; Baylis, Henry I.; Goldberg, Robert A.; Perry, Julian D.

doi:10.1016/s0161-6420(00)00241-4

Cited by 221 publications

(129 citation statements)

References 14 publications

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“…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. Both the transcaruncular 27 and the precaruncular 43 approach can be used in combination with the transconjunctival route and may facilitate excellent exposure of the medial wall.…”

Section: Discussionmentioning

confidence: 88%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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] …”

Section: Introductionmentioning

confidence: 99%

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

Paridaens

Lie

Grootendorst

et al. 2005

Eye

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Objectives To evaluate the efficacy and side effects of 'swinging eyelid' orbital decompression in patients with Graves' orbitopathy (GO). To calculate the incidence of postoperative new-onset diplopia (NOD) using a newly proposed scoring system for diplopia. Methods We reviewed the clinical data on proptosis, visual acuity, and diplopia in 104 consecutive patients (198 orbits) with GO, who underwent orbital decompression. A combined lateral canthal and inferior fornix incision ('swinging eyelid' approach) was used for removal of the medial wall, the orbital floor and, if indicated, the lateral wall. Indications for surgery were disfiguring/ congestive GO (DGO) in 79 patients (149 orbits) and compressive optic neuropathy (CON) in 25 patients (49 orbits). Diplopia was scored according to four grades. In both groups, the incidence of new-onset (continuous) diplopia (NOD), deterioration of diplopia (DOD), and improvement of diplopia (IOD) were calculated, using strictly defined criteria. Our data on NOD were compared to those from other series, after recalculation according to our criteria. Results The mean proptosis reduction was 4.6 mm (range 0-9.5 mm) after three-wall decompression (95 patients, 180 orbits) vs 3.1 mm (range 0-7 mm) after two-wall decompression (nine patients, 18 orbits). The visual acuity improved in 98% of the patients with CON. In patients with DGO, NOD occurred in 14%. In patients with CON, NOD was not observed, but DOD occurred in 41%. Our data compare favourably to the reported incidence of NOD after either transantral or transnasal decompression. Conclusions 'Swinging eyelid' orbital decompression is efficacious for proptosis reduction as well as for optic nerve decompression. A scoring system for standardized evaluation of diplopia is proposed.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Paridaens

Lie

Grootendorst

et al. 2005

Eye

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“…12 On completion of the bony wall decompression, the medial periorbita was opened to allow further expansion of the orbital contents. When performing a three-walled orbital decompression, the postero-medial floor is decompressed by the transcaruncular approach.…”

Section: Medial Orbital Wall Decompression By a Transcaruncular Approachmentioning

confidence: 99%

The effect of orbital decompression surgery on refraction and intraocular pressure in patients with thyroid orbitopathy

Norris

Ross

Kazim

et al. 2012

Eye

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Purpose To investigate the effect of orbital decompression surgery in thyroid orbitopathy (TO) on both refractive status and intraocular pressure (IOP). Patients and methods A prospective, multicentre, consecutive audit of patients undergoing thyroid decompression surgery. Indications for surgery included cosmetically unacceptable proptosis or corneal exposure. Exclusion criteria included the following: previous orbital surgery, glaucoma, corneal disease, steroid use in the preceding 12 months, or an acute optic neuropathy. Automated refraction, keratometry, pachymetry, Hertel exophthalmometry, and IOP were recorded at 1 month pre-and 3 months postoperatively. IOP using the Tono-Pen (mean of three readings) was measured in the primary, upgaze, and downgaze positions. Results Data were collected from 52 orbits of 33 patients (East Grinstead, New York, and Adelaide). There was no significant difference between pre-and postoperative data for sphere, cylinder, or central corneal thickness (CCT). The mean spherical equivalent was À0.43±1.49 D pre-operatively and À0.28±1.52 D postoperatively. The steepest meridian of corneal curvature was 93.1 degrees pre-and 94.2 degrees postoperatively, with no significant difference. Mean IOP significantly decreased when measuring by Goldmann applanation tonometry (GAT) (2.28 mm Hg, *P ¼ 0.001) and Tono-Pen (3.06 mm Hg, *P ¼ o0.0001). IOP measured in upgaze was significantly greater than that in the primary position. Regression analysis between change in IOP and either Hertel exophthalmometry or the number of orbital walls decompressed was non-significant (*Student's t-test). Conclusion Patients with TO undergoing orbital decompression had, on average, with-the-rule astigmatism not affected by orbital decompression surgery. IOP was significantly reduced by decompression surgery although no relationship between IOP and the degree of decompression was observed.

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“…A preferable alternative is the transcaruncular approach, popularized by the University of California-Los Angeles group for several indications. 10 Fractures occur in the thin lamina papyracea inferior to the anterior and posterior ethmoidal foramina. Once the incarcerated tissue has been released, a thin nylon foil is inserted, and supported on stable bone peripheral to the fracture.…”

Section: Surgical Techniquementioning

confidence: 99%

Orbital blow-out fractures: surgical timing and technique

Harris

2006

Eye

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Transcaruncular approach to the medial orbit and orbital apex

Cited by 221 publications

References 14 publications

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

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

The effect of orbital decompression surgery on refraction and intraocular pressure in patients with thyroid orbitopathy

Orbital blow-out fractures: surgical timing and technique

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