A randomized comparative study of inferomedial vs. balanced orbital decompression. Analysis of changes in orbital volume, eyelid parameters, and eyeball position

Pereira, Thaís de Sousa; Leite, Cristiane de Almeida; Kuniyoshi, Cristina Hiromi; Gebrim, Eloísa Maria Mello Santiago; Monteiro, Mário Luiz Ribeiro; Gonçalves, Arthur Lopes

doi:10.1038/s41433-021-01480-7

Cited by 7 publications

(1 citation statement)

References 24 publications

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“…Few studies have investigated factors influencing the visual outcome after orbital decompression in GO, such as duration of the disease, preoperative visual acuity, additional orbital fat reduction, and preoperative degree of exophthalmos [ 16 , 34 , 35 , 36 ]. CT-based volumetric analyses showed a positive correlation between exophthalmos reduction and decompression volume [ 37 , 38 ]. A recent study designed a phantom model to measure the pressure relief at the orbital apex depending on the localization and extent of bony decompression comparing different surgical techniques for orbital decompression.…”

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confidence: 99%

Increased Orbital Muscle Fraction Diagnosed by Semi-Automatic Volumetry: A Risk Factor for Severe Visual Impairment with Excellent Response to Surgical Decompression in Graves’ Orbitopathy

Steiert

Kuechlin

Masalha

et al. 2022

JPM

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Graves’ orbitopathy (GO) leads to increased orbital tissue and causes symptoms such as exophthalmos, functional complaints, or dysthyroid optic neuropathy. Different GO types with fat and/or muscle enlargement were identified, and increased muscle appears to particularly influence visual status and treatment response. The current study examines visual parameters dependent on orbital muscle volume fraction in a surgically treated GO cohort. After volumetric analysis of the preoperative orbital content, 83 orbits in 47 patients were categorized into predefined groups (increased or not-increased muscle fraction). All cases underwent pterional orbital decompression, and pre- and postoperative visual status was retrospectively analyzed. Forty-one orbits revealed increased and 42 orbits revealed not-increased muscle volume (mean fraction 29.63% versus (vs.) 15.60%). The preoperative visual acuity (VA) was significantly lower in orbits with increased vs. not-increased muscle volume (mean VA 0.30 vs. 0.53, difference 2.5 lines). After surgery, mean VA improved significantly by 1.7 lines in orbits with increased muscle volume. Not preoperative, but postoperative exophthalmos was significantly lower in orbits with not-increased muscle volume. Increased orbital muscle is associated with significantly reduced VA, but can be remarkably improved by pterional orbital decompression. Therefore, surgical therapy should be considered particularly in decreased VA with orbital muscle enlargement.

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