scholarly journals Proposing a surgical algorithm for graduated orbital decompression in patients with Graves’ orbitopathy

2021 ◽  
Author(s):  
Kerstin Stähr ◽  
Anke Daser ◽  
Michael Oeverhaus ◽  
Timon Hussain ◽  
Stephan Lang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Postoperative Outcome ◽  
Orbital Decompression ◽  
Double Vision ◽  
Primary Position ◽  
Disease Characteristics ◽  
Graves Orbitopathy ◽  
Disease Parameters ◽  
New Onset

Abstract Purpose To determine the outcome after orbital decompression using a graduated technique, adapting the surgical technique according to individual patients’ disease characteristics. Methods We retrospectively examined the postoperative outcome in patients treated with a graduated balanced orbital decompression regarding reduction of proptosis, new onset diplopia and improvement in visual function. 542 patients (1018 orbits) were treated between 2012 and 2020 and included in the study. Clinical examinations including visual acuity, exophthalmometry (Hertel) and orthoptic evaluation were performed preoperatively and at minimum 6 weeks postoperatively. Mean follow-up was 22.9 weeks. Results Mean proptosis values have significantly decreased after surgery (p < 0.01). In 83.3% of the patients Hertel measurement normalized (≤ 18 mm) after surgery, New onset diplopia within 20° of primary position occurred in 33.0% of patients, of whom 16.0% had preoperative double vision in secondary gaze. Patients suffering from dysthyroid optic neuropathy (DON) had a significant increase in visual acuity (p < 0.01). Conclusion We demonstrated that individually adapted graduated orbital decompression successfully improves key disease parameters of Graves’ orbitopathy with low morbidity.

scholarly journals Descompresión orbitaria endoscópica transnasal en orbitopatía por enfermedad de Graves

2017 ◽  
Vol 2 (3) ◽  
pp. 25-29
Author(s):  
Martín Alonso Pinzón Navarro ◽  
Perla Villamor Rojas
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Orbital Decompression ◽  
San Jose ◽  
Ocular Symptoms ◽  
Case Series Study ◽  
Graves Orbitopathy ◽  
Retrospective Nature ◽  
Series Study

Introducción: La orbitopatía distiroidea ocasiona un aumento del volumen orbitario, exoftalmos y síntomas oculares severos como pérdida de la agudeza visual, diplopía y compromiso del nervio óptico. Los corticoesteroides y la radioterapia han sido usados para su tratamiento pero con efectos secundarios indeseables. La cirugía se puede considerar una de las mejores opciones de manejo.Objetivo: El objetivo del estudio es describir los resultados quirúrgicos de los pacientes con orbitopatía por enfermedad de Graves sometidos a descompresión endoscópica transnasal de órbita en el Hospital de San José en Bogotá, Colombia, entre el año 2009 y 2014.Métodos: Se realizó un estudio descriptivo longitudinal de serie de casos. Se analizaron los datos con base en cambios posoperatorios de agudeza visual, campimetría y exoftalmometría, así como complicaciones posoperatorias.Resultados: Se analizaron 32 órbitas de 16 pacientes. El 83,3% de los pacientes presentaba campimetrías pre y posoperatorias normales, excepto por defectos leves secundarios a ptosis palpebral. El 87,5% presentó agudeza visual preopera- toria peor o igual a 20/50, con mejoría de la agudeza visual en el posoperatorio en el 100% de los casos. La exoftalmometría preoperatoria tuvo una mediana de 24 mm (RIQ: 21,8-27) (DS: 2,77), mientras que la posquirúrgica presentó una mediana de 1,25 mm (RIQ:16-21) (DS: 2,99), la cual se considera un estudio dentro de límites normales. La única complicación reportada fue la presencia de diplopía en 4 de los 16 pacientes (25%), de los cuales una fue transitoria y 3 persistieron durante todo el seguimiento (18,75%).Conclusiones: Existen limitaciones en el estudio al ser retrospectivo descriptivo; sin embargo, los datos obtenidos muestran a la descompresión orbitaria transnasal para orbitopatía de Graves como una intervención segura y eficaz.Abstract Introduction: Dysthyroid orbitopathy causes an increase in orbital volume, exophthalmos and severe ocular symptoms such as loss of visual acuity, diplopia, and optic nerve involvement. Corticosteroids and radiotherapy have been used for treatment but with undesirable side effects. The surgery can be considered one of the best treatment options.Objective: The aim of the study was to describe the surgical outcomes of patients with Graves’ orbitopathy, treated with transnasal endoscopic orbital decompression in Hospital de San José in Bogotá, Colombia, between 2009 and 2014. Methods: A descriptive longitudinal case series study was conducted. Data were analyzed taking into account postsurgical changes of visual acuity, exophthalmometry and campimetry, also postoperative complications. Results: 32 orbits of 16 patients were analyzed. 83.3% of patients had pre and postoperative normal campimetries except slight defects, due to palpebral ptosis. 87.5% had preoperative visual acuity worse or equal than 20/50, with improved visual acuity postoperatively in 100% of cases. The preoperative exophthalmometry 24 mm had a median (IQR 21.8-27) (SD: 2.77), while the postoperative median was 18.25 mm (IQR 16-21) (SD: 2.99), which is considered a normal study. The only complication reported was the presence of diplopia in 4 of the 16 patients (25%), of which 1 was transient and 3 persisted throughout follow-up (18.75%).Conclusions: There are limitations on the study due to its retrospective nature, but the data showed the transnasal orbital decompression for Graves orbitopathy as a safe and effective intervention.

Rehabilitative Orbital Decompression for Graves' Orbitopathy: Risk Factors Influencing the New Onset of Diplopia in Primary Gaze, Outcome, and Patients' Satisfaction

Thyroid ◽  
2012 ◽  
Vol 22 (11) ◽  
pp. 1170-1175 ◽  
Author(s):  
Roberto Rocchi ◽  
Riccardo Lenzi ◽  
Michele Marinò ◽  
Francesco Latrofa ◽  
Marco Nardi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Orbital Decompression ◽  
Patients Satisfaction ◽  
Factors Influencing ◽  
Graves Orbitopathy ◽  
New Onset

scholarly journals Visual acuity and its postoperative outcome after transsphenoidal adenoma resection

2020 ◽  
Author(s):  
Vicki M. Butenschoen ◽  
Nina Schwendinger ◽  
Alexander von Werder ◽  
Stefanie Bette ◽  
Maximilian Wienke ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Function ◽  
Tumor Resection ◽  
Postoperative Outcome ◽  
High Volume ◽  
Transsphenoidal Approach ◽  
Invasive Treatment ◽  
Neurosurgical Department ◽  
Radiographic Findings

Abstract Transsphenoidal surgery (TSS) represents the gold standard of pituitary adenoma resection, providing a safe and minimal invasive treatment for patients suffering from symptoms of mass effect. The aim of this study is to analyze the postoperative improvement of visual function after adenoma resection and to identify prognostic factors for the postoperative clinical recovery. We performed a retrospective analysis of all consecutive patients treated via a transsphenoidal approach for pituitary adenomas from April 2006 to December 2019 in a high-volume neurosurgical department. Our primary outcome was postoperative visual acuity and visual field impairment; the clinical findings were followed up to 3 months after surgery and correlated with clinical and radiographic findings. In total, 440 surgeries were performed in our department for tumors of the sella region in a time period of 13 years via transsphenoidal approach, and 191 patients included in the analysis. Mean age was 55 years, and 98% were macroadenomas. Mean preoperative visual acuity in patients with preoperative impairment (n = 133) improved significantly from 0.64/0.65 to 0.72/0.75 and 0.76/0.8 (right eye R/left eye L) postoperatively and at 3 months follow-up (p < 0.001). Visual acuity significantly depended on Knosp classification but not Hardy grading. The strongest predictor for visual function recovery was age. Transsphenoidal pituitary tumor resection remains a safe and effective treatment in patients with preoperative visual impairment. It significantly improves visual acuity and field defects after surgery, and recovery continues at the 3 months follow-up examination.

scholarly journals A report on the postoperative outcome of MyIOL603YP implantation in Hospital Melaka

2019 ◽  
Vol 1 (2) ◽  
pp. 126-132
Author(s):  
Khavigpriyaa Kalaichelvam
Keyword(s):  
Visual Acuity ◽  
Sampling Method ◽  
Intraoperative Complications ◽  
Postoperative Outcome ◽  
Posterior Capsule Opacification ◽  
Postoperative Visual Acuity ◽  
Convenience Sampling ◽  
To Receive ◽  
Preoperative Examination

This study reports the experience and outcomes of a new monofocal intraocular lens (IOL) by the name of MyIOL603YP. The performance of MyIOL603YP over a 2-month follow-up period from June to December 2016 was assessed. Twenty-nine patients, one eye from each patient, were recruited by convenience sampling method and were evaluated prospectively. Patients who were eligible to receive welfare IOLs were chosen. Detailed, preoperative examination was done, and the surgical procedure was the same for all, which was phacoemulsification with MyIOL603YP implantation with random surgeon selection. Intraoperative complications were recorded by the surgeon. Postoperative examination was done during follow-up at one week and two months post cataract operation.Results were obtained from 22 eyes (7 defaulted). Twenty eyes (84.7%) achieved an unaided postoperative visual acuity of 6/12 or better. There were no intraoperative or postoperative complications. There was no reported inflammation two months after cataract surgery with implantation of MyIOL603YP and no posterior capsule opacification was reported.

RESOLUTION OF CHOROIDAL FOLDS AND IMPROVEMENT IN VISUAL ACUITY AFTER ORBITAL DECOMPRESSION FOR GRAVES ORBITOPATHY

Retina ◽  
2003 ◽  
Vol 23 (4) ◽  
pp. 563-565 ◽  
Author(s):  
RODRIGO JORGE ◽  
INGRID U. SCOTT ◽  
PATRICIA MITIKO S. AKAISHI ◽  
ANTONIO A. VELASCO CRUZ ◽  
HARRY W. FLYNN
Keyword(s):  
Visual Acuity ◽  
Orbital Decompression ◽  
Choroidal Folds ◽  
Graves Orbitopathy

scholarly journals Gamma Knife Radiosurgery for Tuberculum Sellae Meningiomas: A Series of 78 Consecutive Patients

2022 ◽  
Author(s):  
Yavuz Samanci ◽  
Gokce Deniz Ardor ◽  
Selcuk Peker
Keyword(s):  
Visual Acuity ◽  
Gamma Knife ◽  
Medical Records ◽  
Gamma Knife Radiosurgery ◽  
Target Volume ◽  
Imaging Studies ◽  
Kaplan Meier ◽  
Tuberculum Sellae ◽  
New Onset

Abstract Background: Outcomes of Gamma Knife Radiosurgery (GKRS) for tuberculum sellae meningiomas (TSMs) have not been reported explicitly within any meningioma series. We present the first and largest TSM series with clinical, radiosurgical, and outcome features for 78 consecutive patients managed with GKRS. Methods: Patients who underwent GKRS for TSMs between 2005 and 2021 and had a minimum of 6 months of follow-up were included. Medical records, imaging studies, and follow-up examinations were evaluated retrospectively.Results: A total of 78 patients with a median age of 50.5 years were included. SRS was conducted as an upfront treatment for 38 patients (48.7%). The median target volume was 1.7 cm3 (range, 0.1-14.6). During a median follow-up of 78.5 months, the cumulative PFS rates of the whole cohort at 1, 5, and 10 years by Kaplan-Meier analysis were 100%, 97.9%, and 94.5%, respectively. Of 47 patients with impaired vision, improvement and/or preservation of visual acuity and visual field were achieved in 55.3% and 42.6%, respectively. No new-onset hormonal deficits were observed.Conclusions: Based on our data, SRS represents an effective and safe modality for unresected or recurrent/residual TSMs. SRS should be offered to patients who are not willing or not ideal candidates for surgery.

Medial Wall Orbital Decompression in Graves’ Orbitopathy

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P40-P40
Author(s):  
Stefano Sellari-Franceschini
Keyword(s):  
Retrospective Analysis ◽  
Extraocular Muscles ◽  
Medial Wall ◽  
Orbital Decompression ◽  
Graves Orbitopathy ◽  
New Onset

Objective 1) To delineate useful criteria when choosing between different techniques for orbital decompression. 2) To discuss indications and limits of the medial wall only approach. Methods A retrospective analysis was made of the medical charts of 256 patients operated on by a single surgeon from 1998 to 2006. 228 patients were operated on using a balanced technique, 17 by an inferomedial decompression, 11 by a medial decompression. Patients operated on by the medial wall removal had a mild to moderate proptosis, and a slight involvement of the extraocular muscles in the disease. Results Mean proptosis reduction was 4 mm with the inferomedial approach, 5.5 mm with the balanced procedure, and 2.6 mm with the medial wall removal. Postoperative deterioration or new onset of diplopia was 29% after inferomedial orbital decompression, 17.1% after balanced decompression, and 9% after medial wall removal. Conclusions When a proptosis reduction of less than 3 mm is needed, the medial wall approach is suggested. When a greater proptosis reduction is needed, a balanced decompression is advisable, since the inferomedial approach carries with it a higher risk of postoperative diplopia.

scholarly journals Ophthalmological findings in children with non-syndromic craniosynostosis: preoperatively and postoperatively up to 12 months after surgery

2021 ◽  
Vol 6 (1) ◽  
pp. e000677
Author(s):  
Evangelia Ntoula ◽  
Daniel Nowinski ◽  
Gerd Holmstrom ◽  
Eva Larsson
Keyword(s):  
Visual Acuity ◽  
University Hospital ◽  
Cranial Sutures ◽  
Sagittal Craniosynostosis ◽  
Syndromic Craniosynostosis ◽  
Disc Oedema ◽  
Before And After ◽  
Congenital Condition ◽  
Skull Deformity

AimsCraniosynostosis is a congenital condition characterised by premature fusion of one or more cranial sutures. The aim of this study was to analyse ophthalmic function before and after cranial surgery, in children with various types of non-syndromic craniosynostosis.MethodsChildren referred to Uppsala University Hospital for surgery of non-syndromic craniosynostosis were examined preoperatively. Visual acuity was measured with Preferential Looking tests or observation of fixation and following. Strabismus and eye motility were noted. Refraction was measured in cycloplegia and funduscopy was performed. Follow-up examinations were performed 6–12 months postoperatively at the children’s local hospitals.ResultsOne hundred twenty-two children with mean age 6.2 months were examined preoperatively. Refractive values were similar between the different subtypes of craniosynostosis, except for astigmatism anisometropia which was more common in unicoronal craniosynostosis. Strabismus was found in seven children, of which four had unicoronal craniosynostosis.Postoperatively, 113 children were examined, at mean age 15.9 months. The refractive values decreased, except for astigmatism and anisometropia in unicoronal craniosynostosis. Strabismus remained in unicoronal craniosynostosis. Two new cases with strabismus developed in unicoronal craniosynostosis and one in metopic, all operated with fronto-orbital techniques. No child had disc oedema or pale discs preoperatively or postoperatively.ConclusionOphthalmic dysfunctions were not frequent in children with sagittal craniosynostosis and preoperative ophthalmological evaluation may not be imperative. Children with unicoronal craniosynostosis had the highest prevalence of strabismus and anisometropia. Fronto-orbital techniques used to address skull deformity may be related to a higher prevalence of strabismus postoperatively.

scholarly journals Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Peter Tschann ◽  
Nikola Vitlarov ◽  
Martin Hufschmidt ◽  
Daniel Lechner ◽  
Paolo N. C. Girotti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Resection ◽  
Postoperative Outcome ◽  
Resection Margins ◽  
Pain Level ◽  
Histopathological Findings ◽  
Vas Score ◽  
Reduction Of Pain

Abstract Introduction Endometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis. Methods Twenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome. Results Average follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54). Conclusion Our data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

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