Descompressão endoscópica orbitária na oftalmopatia de Graves

Abstract

A orbitopatia de Graves pode levar à exoftalmia significativa com alterações cosméticas até à própria perda visual. O tratamento cirúrgico desta doença era então realizado através de descompressão orbitária por via externa. Entretanto, técnicas minimamente invasivas através da descompressão orbitária por via endoscópica agora são possíveis, possibilitando a remoção da parede medial e inferior da órbita sem a realização de incisões cutâneas ou gengivais, permitindo a redução média da proptose comparável com as técnicas externas. Este artigo de revisão tem por objetivo descrever os passos técnicos em detalhe, enfocando suas vantagens e desvantagens. A descompressão orbitária por via endoscópica é um procedimento seguro e efetivo para o tratamento da exoftalmia tireoideana.

Ophthalmological profile of patients with thyroid diseases in Fortaleza, Ceará, Brazil: glaucoma investigation

“…Exophthalmos, resulting from this process, can increase IOP, causing damage to episcleral venous drainage, with the possible consequent progression of glaucomatous damage. [28][29] The present study found a higher prevalence of POAG (8.0% of the sample analyzed, against zero other types of glaucoma) among thyroid patients. However, there is still a need to continue investigating the possible mechanisms that exist in this possible relationship and its development, in order to determine whether thyroid disorders instigate and / or aggravate glaucomatous damage.…”

Malignant Graves’ Ophthalmopathy

“…Late diagnosis is harmful due to the fact that malignant disease is extremely aggressive and fast [4], as reported in this case. Most often, the ophthalmopathy follows a relatively mild and self-limiting course, making a proper diagnosis difficult if the disease progresses [4] [7].…”

“…Late diagnosis is harmful due to the fact that malignant disease is extremely aggressive and fast [4], as reported in this case. Most often, the ophthalmopathy follows a relatively mild and self-limiting course, making a proper diagnosis difficult if the disease progresses [4] [7]. Patients with severe congestive status or optic nerve involvement show a significant improvement when treated with corticosteroids, radiotherapy and immunosuppressive drugs [4] [7] [8].…”

“…Most often, the ophthalmopathy follows a relatively mild and self-limiting course, making a proper diagnosis difficult if the disease progresses [4] [7]. Patients with severe congestive status or optic nerve involvement show a significant improvement when treated with corticosteroids, radiotherapy and immunosuppressive drugs [4] [7] [8]. In our case, we used pulse therapy with hydrocortisone, which caused an initial improvement of visual acuity and partial retraction of proptosis, evolving into new worsening symptoms.…”

“…The pathogenesis of ophthalmopathy may involve cytotoxic antibodies and cytotoxic lymphocytes sensitized to an antigen common fibroblasts in the orbit, orbital muscles, fatty tissue posterior ocular and thyroid tissue. Cytokines of these sensitized lymphocytes would cause inflammation of orbital fibroblasts and orbital myositis, resulting in swelling of the orbital muscles, eyelid retraction, proptosis of the eyeballs and diplopia, as well as erythema, congestion and decreased venous drainage, causing swelling conjunctival and periorbital [3] [4].…”