This study examines the usefulness of both geometric and volumetric measurements of orbital soft tissues on CT scans to provide quantitative diagnostic guidance in image reading of thyroid eye disease (TED). Computed tomography (CT) images were obtained from 92 orbits and were classified as impaired motility (TED-IM) and normal motility (TED-NM). The TED-IM group was further divided into dysthyroid optic neuropathy (DON) and non-DON groups. There were 5 volumetric, 2 angular, and 3 ratio parameter measurements acquired from CT images to examine their feasibility in TED classification. We found that the mean volumes of extraocular muscle and retroorbital fat and their ratio to the orbital volume were significantly different between the two motility groups. The mean ratio of extraocular muscle volume in orbital apex and orbital apex volume (EMV-OA/OAV) was significantly larger in DON than non-DON patients (p < 0.05). The population distribution among TED-NM, non-DON, and DON groups significantly varied for different angles between the optic nerve and medial rectus and lateral rectus. In conclusion, geometric and volumetric measurements using CT scans help to quantitatively classify TED.

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Purpose. To deeply discuss the patient selection, surgical planning, surgical techniques, and the therapeutic challenge for endoscopic transnasal resection of benign orbital apex tumors (OATs). Methods. We retrospectively analyzed the cases of 18 patients (18 eyes) with orbital apex cavernous hemangioma (OACH) who underwent endoscopic transnasal approach for resection of the tumor in Zhongshan Ophthalmic Center from March 2016 to May 2020. At each follow-up visit, the patients underwent measurement of their best-corrected visual acuity (BCVA), slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Results. There were 18 patients, 7 males and 11 females, with a mean age of 49.9 ± 12.6 years (range: 26 to 70 years). All 18 patients had unilateral tumors. Among the 18 cases, 13 were located in the right orbit and 5 were located in the left orbit. Sixteen patients underwent purely endoscopic transnasal surgery, and the other 2 patients underwent an endoscopic transnasal approach combined with a transcutaneous or transconjunctival surgical approach. Fourteen patients’ OACHs were removed completely, 1 patient’s OACH was partly removed, and 3 patients underwent pure decompression of the optic nerve. Fourteen patients gained improved or stable BCVA after surgery. Three patients showed postoperative vision decline, and 1 patient had no light perception after surgery. Conclusions. Endoscopic surgery is an effective surgical technique for the treatment of benign tumors in the orbital apex. It is necessary to strictly select patients and fully evaluate the benefits and risks of tumor completely or partly removed.

Objectives: To standardize the endoscopic deep medial orbital decompression surgery for better relief of optic nerve compression in dysthyroid optic neuropathy (DON). Methods: A total of 128 eyes from patients received the standardized endoscopic deep medial orbital decompression surgery were recruited in this study. The efficacy of the procedure was assessed at a one-month follow-up by the best-corrected visual acuity (VA), visual field (VF), and visual evoked potential (VEP). Clinical data were collected to explore the factors that affected visual recovery. Oxygen saturation of retinal blood vessels, retinal thickness, and vessel density were measured to demonstrate the potential recovery mechanisms. Results: After surgery, the ratio of extraocular muscle volume in the orbital apex to orbital apex volume significantly decreased from 44.32 ± 22.31% to 36.82 ± 12.02% (P < 0.001). 96.87% of eyes’ final VA improved, average VA improved from 0.93 ± 0.73 to 0.50 ± 0.60 at 1 week (P < 0.001) and 0.40 ± 0.53 at 1 month (P < 0.001). Postoperatively VF and VEP also improved, the oxygen saturation of retinal arteries increased, and the retinal thickness was reduced. Preoperative VA, visual impairment duration, and clinical activity score evaluation were associated with visual recovery. Conclusions: In this study, we standardized the endoscopic deep medial orbital decompression, of which key point was to relieve pressure in the orbital apex and achieved satisfactory visual recovery in DON patients.