Endoscopic Orbital Decompression for Graves’ Orbitopathy – A Vietnam Study

Figures & data

Figure 1 Technique in endoscopic orbital decompression. (A) Maxillary antrostomy; (B) complete ethmoidectomy; (C) lamina papyracea removal; (D) fracture of the medial orbital floor; (E) periorbita incision; (F) orbital fat herniation into the nasal cavity.

Abbreviations: UP, uncinate process; MT, middle turbinate; E, ethmoid cells; LP, lamina papyracea; P, periorbita; SB, skull base; OF, orbital floor; F, orbital fat.

Table 1 Characteristics of Patients and Orbits Before Surgery

Presenting Signs		Patient (n=15)	Orbit (n=28)
Euthyroidism		15
Compressive optic neuropathy		4	6
Proptosis		12	22
Active phase (CAS >3)		1	1
Diplopia		2
Previous surgery	Medial + Inferior wall open decompression	2	3
	Corticosteroid pulse therapy	4	6

Abbreviation: CAS, Clinical Activity Score.

Table 2 Preoperative and Postoperative Clinical Finding of Patients with Compressive Optic Neuropathy

Patient’s Number and Eye Side	Time Between Optic Neuropathy – Steroid Treatment (Week)	Time Between Final Steroid Treatment – Endoscopic Decompression (Week)	Visual Acuity		Mean Deviation (dB)		Ishihara Color Test (Plates/38)		Avg.RNFL (µm) on OCT
					Humphrey Visual Field
			Pre-Op	Post-Op	Pre-Op	Post-Op	Pre-Op	Post-Op	Pre-Op	Post-Op
No1/Right eye	0	12	6/60	6/7.5	−17.3	−3.18	30/38	38/38	109.69	105.14
No1/Left eye	12	12	CF 0.5 m	CF 0.5 m	−18.23	−17.66	0/38	0/38	86.01	79.22
No2/Right eye	36	60	HM	HM	Not determined	Not determined	0/38	0/38	58.13	56.46
No3/Right eye	14	2	6/18	6/6	−12.77	− 4.36	38/38	38/38	116.2	119
No4/Right eye	4	4	6/30	6/7.5	− 22.75	− 5.16	0/38	38/38	115.53	103.28
No4/Left eye	4	4	6/60	6/9	− 19.69	− 4.9	0/38	38/38	129.94	107.2

Abbreviation: Avg.RNFL, average retinal nerve fiber layer thickness.

Table 3 Effects of Surgical Procedure on Diplopia and Proptosis

Surgical Procedure	Number of Patients with Newly Developed or Worsen Diplopia, Last >3 Months	Number of Patients without Newly Developed or Worsen Diplopia	Mean Proptosis Reduction (mm)
Orbital strut + inferior wall removal	3	4	3.00 ± 0.52
Anterior floor (Orbital strut + inferior wall) preservation	0	8	1.66 ± 0.81