Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves’ orbitopathy

Abstract

Background: To determine the clinical outcomes and morbidity of endoscopic medial wall combined with transcutaneous lateral orbital wall decompression in Graves’ orbitopathy.

Methodology: A retrospective noncomparative case series of patients who underwent surgical decompression for Graves’ orbitopathy at Hospital Universitario de Fuenlabrada between 2004 and 2014 was performed. We reviewed the patients’ charts and analyzed before and after the decompression, the visual acuity (Snellen chart), optic nerve compression (fundoscopy and optic coherence tomography), exophthalmometry (Hertel measurement), ocular motility, diplopia, eyelid surgery needed after decompression and its possible complications.

Results: A total of 20 patients (36 orbits) were operated. The mean follow-up was 44 months (range 18–84). Vision improved dramatically in all compressive optic neuropathy cases (5 cases). Hertel measurements improved on average 3.5 mm (range 1.5–4.5). Diplopia was cured in eight patients (40%) and nine patients with severe preoperative diplopia required strabismus surgery after decompression. Eyelid surgery was further needed in 13 patients. Hyaluronic acid injection was the most used technique for the treatment of eyelid retraction (6 out of 13 patients). Only two major complications were observed: one case had a major post-operative epistaxis and another a cerebrospinal fluid leak. Both were resolved without further sequelae.

Conclusions: These results suggest that endoscopic medial wall combined with transcutaneous lateral wall orbital decompression is an effective and safe treatment for the symptomatic dysthyroid eye disease with important proptosis or compressive optic neuropathy.

Chinese abstract

背景：确定内窥镜内壁结合经皮侧眼眶壁减压术对治疗格雷夫斯眼病的临床疗效和发病率。

方法：在2004年至2014年间, 对在Fuenlabrada大学医院接受了格雷夫斯眼病减压手术的患者进行了回顾性非比较系列研究。我们审视了患者图表, 分析了减压前后的视力（Snellen图）、视神经压迫（透视和视觉相干断层扫描）、眼球测量（Hertel测量）、眼睛运动、复视、减压后需要的眼睑手术以及可能的并发症。

结果：共为20例患者（36个眼眶）动了手术。平均随访时间为44个月（范围18-84）。在所有压迫性视神经病变病例中, 视力均明显改善（5例）。 Hertel测量平均增加3.5 mm（范围1.5-4.5）。 8例（40%）治愈Diplopia。9例重度术前复视患者减压后需要斜视手术。 13例患者需要进一步的眼睑手术。透明质酸注射液是治疗眼睑退缩的最常用技术（13例患者中有6例）。仅观察到两个主要并发症：一例发生术后鼻窦炎, 另一例脑脊液泄漏。两者都得到解决, 没有进一步的后遗症。

结论：这些结果表明, 内窥镜内壁结合经皮侧壁眼眶减压术是对重要的视神经病变或压迫性视神经病变的症状性甲状腺病变眼病的有效安全的治疗方法。

Keywords:

• Thyroid eye disease
• orbit
• decompression
• diplopia
• proptosis
• compressive optic neuropathy

Disclosure statement

No potential conflict of interest was reported by the authors.