Minimization of Extraocular Muscle Damage in Thyroid Eye Disease Patients Following Surgery Based on Computerized Biomechanics

Abstract Background To evaluate the risk of general orbital decompression in patients with thyroid eye disease (TED).Methods In this study, we replicated the behavior of intraorbital tissue in patients with TED based on finite element analysis. The orbit and intraorbital tissues of TED patient who underwent orbital decompression were modeled as finite element models. The stress was examined at a specific location of the removed orbital wall of a patient with TED who had undergone orbital decompression, and its variation was investigated and analyzed as a function of the shape and dimension (to be removed).Results In orbital decompression surgery which removes the orbital wall in a rectangular shape, the stress at the orbital wall decreased as the width and depth of the removed orbital wall increased. In addition, the stress of the non-chamfered model (a form of general orbital decompression) was higher than that of the chamfered model. Especially, in the case of orbital decompression, it can be seen that the chamfered model compared to the non-chamfered model have the stress reduction rate from 11.08% to 97.88%.Conclusions It is inferred that if orbital decompression surgery considering the chamfered model is performed on an actual TED patient, it is expected that the damage to the extraocular muscle caused by the removed orbital wall will be reduced.

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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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Patients’ expectations for the functional and psychosocial outcomes of orbital decompression surgery for thyroid eye disease: a qualitative study

Psychology Health & Medicine ◽

10.1080/13548506.2017.1356930 ◽

2017 ◽

Vol 23 (4) ◽

pp. 475-484

Author(s):

Sadie Wickwar ◽

Hayley McBain ◽

Matthew R. Edmunds ◽

Daniel G. Ezra ◽

Geoffrey E. Rose ◽

...

Keyword(s):

Qualitative Study ◽

Psychosocial Outcomes ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Decompression Surgery ◽

Orbital Decompression

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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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