Balanced orbital decompression in Graves' orbitopathy: Upper eyelid crease incision for extended lateral wall decompression

Purpose. To describe the results of thyroid-related orbitopathy (TRO) treated by ultrasonic deep lateral wall bony decompression with partial rim sparing (DLW-PRS). Methods. A review was carried out, from January 2015 to September 2017, of all patients treated with ultrasonic DLW-PRS decompression using a SONOPET® (Stryker, Kalamazoo, MI, USA) ultrasonic aspirator, using a lateral, small triangle flap incision for access. The primary outcome was the change in proptosis (measured by the difference in Hertel exophthalmometry measurements). Other secondary outcomes were changes in visual acuity (VA) (using Snellen scale, decimal fraction), presence of lagophthalmos, eyelid retraction (measured by upper eyelid margin distance to the corneal reflex (MRD1) and lower eyelid margin distance to the corneal reflex (MRD2), and presence of exposure keratopathy). Results. A total of 58 orbital decompressions in 35 patients were reviewed, with 23 patients (65.7%) having bilateral decompressions. There was a female preponderance with 26 patients (74.2%), and the mean age ± standard deviation was 52.6 ± 13.9 years. Mean proptosis was 24.51 ± 1.76 mm preoperatively, reduced to 19.61 ± 1.27 mm in final follow-up. The mean reduction was 4.9 ± 1.54 mm. VA improved from 0.8 ± 0.14 to 0.9 ± 0.12, p=0.039. 5 of 13 patients (38.4%) with preoperative diplopia reported improvement or complete resolution after surgery. MRD1 was reduced from 5.25 ± 0.88 mm to 4.49 ± 0.7 mm. MRD2 was also reduced from 6.3 ± 0.88 mm to 5.0 ± 0.17 mm. Presence of lagophthalmos was reduced from 35 eyes (60.3%) to five (8.6%); the presence of epiphora was also reduced from 20 patients (57.1%) to 3 (8.5%) following decompression. Complications of the surgery included zygomatic hypoaesthesia in 14 (40%) patients in the early postoperative period and chewing alterations in 10 (28.5%) of the patients. All of these complications were resolved at the 6-month follow-up visit. We noted no surgical complications such as ocular or soft tissue damage, infection, inflammation, or visual loss. Conclusions. The SONOPET® ultrasonic bone curette can be used safely and effectively for DLW orbital decompression surgery. The main benefits were good visualization and handling of tissues and speed and ease of use of the equipment. This trial is registered with ClinicalTrials.gov identifier: NCT04025034.

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Upper Eyelid Contour Changes After Orbital Decompression in Graves Orbitopathy

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0000000000002093 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Antonio A. V. Cruz ◽

Bruna Equitério ◽

Stefania B. Diniz ◽

Denny M. Garcia ◽

Daniel B. Rootman ◽

...

Keyword(s):

Orbital Decompression ◽

Upper Eyelid ◽

Graves Orbitopathy

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Lateral wall orbital decompression in Graves’ orbitopathy

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2009.10.011 ◽

2010 ◽

Vol 39 (1) ◽

pp. 16-20 ◽

Cited By ~ 17

Author(s):

S. Sellari-Franceschini ◽

R. Lenzi ◽

A. Santoro ◽

L. Muscatello ◽

R. Rocchi ◽

...

Keyword(s):

Lateral Wall ◽

Orbital Decompression ◽

Graves Orbitopathy

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How Effective is Superolateral Orbital Decompression in Cases of Drug-Resistant Graves’ Ophthalmopathy

Folia Medica ◽

10.3897/folmed.62.e49313 ◽

2020 ◽

Vol 62 (3) ◽

pp. 462-467

Author(s):

Todor Shamov ◽

Tihomir Eftimov ◽

Georgi Krasimirov

Keyword(s):

Visual Acuity ◽

Surgical Techniques ◽

Lateral Wall ◽

Clinical Feature ◽

Muscle Dysfunction ◽

Orbital Decompression ◽

Upper Eyelid ◽

Therapeutic Modalities ◽

Medical Academy ◽

The Mean

Introduction: Graves’ ophthalmopathy (GO) is the most common and difficult-to-treat extrathyroidal symptom of Graves’ disease. Though retraction of the upper eyelid is the most common clinical feature of GO, it can have a much more severe clinical manifesta-tion with symptoms such as conjunctival chemosis, keratopathy, extraocular muscle dysfunction, proptosis of the bulb and dysthyroid optic neuropathy. Treatment methods include control of the thyroid function, corticosteroid and immunosuppressive therapy as well as radiotherapy. These approaches are ineffective in one-third of cases, with patients being refractory to all aforementioned therapeutic modalities. In these cases, surgical decompression of the orbit is in order.The spectrum of surgical techniques is wide and varies from decompression of the lateral wall of the orbit to decompression via removal of all four orbital walls. The aim of the current study was to evaluate the results of superolateral orbital decompression. Patients and methods: The study is retrospective and covers the period from January 2009 to January 2019. During that period eight patients with Graves’ ophthalmopathy underwent surgery and were followed up in the Department of Neurosurgery in the Mili-tary Medical Academy, Sofia. The mean age of the patients was 57 years, with the youngest being 30 years old and the oldest – 74 years old. The gender distribution was 1.6/1 with predominance in females (5 women and 3 men). The surgical approach we used is a com-bination of lateral and upper orbitotomy and was described in detail by Al-Mefty. All of patients underwent ophthalmic examinations in the pre- and postoperative period, with special attention to their visual acuity, the condition of the eyelid and the width of the ocular slit. Exophthalmometry was obtained via Hertel’s method. The participants in this study are followed for a period of six months after the operation. Results: All eight patients underwent superolateral orbitotomy. There were a total of ten orbital decompressions. Improvement of visual acuity and reduction of the proptosis were reported in all other surgically treated patients. The mean reported improvement of visual acuity (measured via Snellen’s method) was 0.27±0.17. The mean reported a reduction of proptosis was 7.53±2.58 mm. Conclusions: Although the surgical techniques for orbital decompression we used have significant disadvantages, they remain the only alternative in order to avoid the complication of severe GO.

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Ocular motility changes after inferomedial wall and balanced medial plus lateral wall orbital decompression in Graves’ orbitopathy: a randomized prospective comparative study

Clinics ◽

10.6061/clinics/2021/e2592 ◽

2021 ◽

Vol 76 ◽

Author(s):

Cristiane de Almeida Leite ◽

Thaís de Sousa Pereira ◽

Jeane Chiang ◽

Rodrigo Bernal Moritz ◽

Allan Christian Pieroni Gonçalves ◽

...

Keyword(s):

Comparative Study ◽

Lateral Wall ◽

Ocular Motility ◽

Orbital Decompression ◽

Prospective Comparative Study ◽

Graves Orbitopathy

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Correlation between uniocular deviation and duction changes following different decompression surgeries in thyroid eye disease

BMC Ophthalmology ◽

10.1186/s12886-021-01892-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jie Guo ◽

Xiaofeng Li ◽

Ruiqi Ma ◽

Jiang Qian

Keyword(s):

Computed Tomography ◽

Lateral Wall ◽

Contractile Force ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Decompression Surgery ◽

Inferior Wall ◽

Orbital Decompression ◽

Significant Difference ◽

Ocular Deviation

Abstract Background Postoperative ocular imbalance is an important problem for orbital decompression surgery in thyroid eye disease (TED). The aim of this study was to evaluate the changes in unilateral ocular deviation and duction following orbital decompression and discuss the biomechanics of ocular imbalance. Methods Fifty-four TED patients who underwent unilateral orbital decompression were included. Fifteen patients underwent 1-wall (deep lateral wall) decompression, 18 patients underwent 2-wall (deep lateral and medial wall) decompression and 21 patients underwent 3-wall (deep lateral, medial and inferior wall) decompression. Objective and subjective deviation of the operated eyes were evaluated using the prism test and synoptophore, respectively. Ocular ductions were measured using Hirschberg’s method. The diameters of the extraocular rectus were measured by computed tomography. Results Ocular deviation and duction showed no significant difference after 1-wall decompression (p = 0.25–0.89). Esotropia increased after 2-wall decompression (p = 0.001–0.02), and hypotropia increased after 3-wall decompression (p = 0.02). Adduction increased but abduction decreased following 2-wall and 3-wall decompression (p < 0.05). Infraduction increased following 3-wall decompression (p < 0.001). Additionally, the increase in esotropia was significantly correlated with the increase in adduction and with the decrease in abduction (r = 0.37–0.63, p < 0.05). There were significant correlations between the diameter of the medial rectus and the increase in esotropia, the increase in adduction and the decrease in abduction postoperatively (r = 0.35–0.48, p < 0.05). Conclusions The changes in ocular deviation and duction were different after 1-wall, 2-wall and 3-wall orbital decompression. The increased contractile force of the rectus may be an important reason for strabismus changes after orbital decompression surgery.

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Upper eyelid retraction disclosed after edrophonium chloride administration in a patient with Graves' orbitopathy and myasthenia gravis

Clinical Ophthalmology ◽

10.2147/opth.s29408 ◽

2012 ◽

pp. 807

Author(s):

Hirohiko Kakizaki ◽

Kang ◽

Yasuhiro Takahashi ◽

Iwaki ◽

Asamura

Keyword(s):

Myasthenia Gravis ◽

Eyelid Retraction ◽

Upper Eyelid ◽

Upper Eyelid Retraction ◽

Graves Orbitopathy

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Correlation Between Uniocular Deviation and Duction Changes Following Different Decompression Surgeries in Thyroid Eye Disease

10.21203/rs.3.rs-121874/v1 ◽

2020 ◽

Author(s):

Jie Guo ◽

Xiaofeng Li ◽

Ruiqi Ma ◽

Jiang Qian

Keyword(s):

Lateral Wall ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Decompression Surgery ◽

Inferior Wall ◽

Orbital Decompression ◽

Orbital Cavity ◽

Significant Difference ◽

Ocular Deviation ◽

Fellow Eyes

Abstract Background: Postoperative ocular imbalance is an important problem for orbital decompression surgery in thyroid eye disease (TED). To evaluate the changes of unilateral ocular deviation and duction following orbital decompression and discuss the possible biomechanics of ocular imbalance.Methods: Fifty-four TED patients who underwent unilateral orbital decompression were included. 15 patients underwent 1-wall (deep lateral wall) decompression, 18 patients underwent 2-wall (deep lateral and medial wall) decompression and 21 patients underwent 3-wall (deep lateral, medial and inferior wall) decompression. Objective and subjective deviation of the operated eyes compared with the fellow eyes were evaluated using prism test and synoptophore, respectively. Ocular ductions were measured using Hirschberg’s method. The diameters of extraocular rectus were measured by computed tomography.Results: Ocular deviation and duction showed no significant difference after 1-wall decompression (p=0.25~0.89). Esotropia increased after 2-wall decompression (p=0.001~0.02). Hypotropia increased after 3-wall decompression (p=0.02). Adduction increased but abduction decreased following 2-wall and 3-wall decompression (p<0.05). Infraduction increased following 3-wall decompression (p<0.001). Additionally, the increase of esotropia had significant correlations with the increase of adduction and with the decrease of abduction (r=0.37~0.63, p<0.05). There were significant correlations between the diameter of medial rectus and the increase of esotropia, the increase of adduction and the decrease of abduction postoperatively (r=0.35~0.48, p<0.05).Conclusions: The changes in ocular deviation and duction were different after 1-wall, 2-wall and 3-wall orbital decompression. The expansion of orbital cavity and the increased contractile force of rectus might be important reasons for strabismus changes following decompression surgery.

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