Balanced Orbital Decompression Combined With Fat Removal in Graves Ophthalmopathy

Abstract

Balanced medial and lateral wall decompression combined with orbital fat removal provides an effective reduction in proptosis and reduces the incidence of postoperative permanent diplopia when compared with 3-wall decompression. This technique may eliminate the need for orbital floor excision.

Efficacy and side effects of ‘swinging eyelid’ orbital decompression in Graves' orbitopathy: a proposal for standardized evaluation of diplopia

“…18 Recalculation of data from studies on anterior approach three-wall orbital decompression, including translid, transconjunctival ('swinging eyelid'), and coronal techniques show relatively low NOD frequencies of 0 to 33% (Table 6). Although it was speculated that a 'balancing effect' of lateral and medial wall decompression may limit the frequency of NOD, 7,24,26,31,35,38 recent studies 25,30 failed to show a difference between translid or transconjunctival two-wall decompression and coronal three-wall decompression in that respect.…”

“…1 Transantral as well as transnasal orbital decompression have been reported to induce diplopia in up to 73% of patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] After translid, transconjunctival, transcaruncular, [21][22][23][24][25][26][27][28][29][30] and coronal orbital decompression, 25,[30][31][32][33] as well as after combinations of these techniques, [34][35][36][37][38][39][40] diplopia was observed less frequently, while orbital fat removal seems to carry the lowest risk of inducing diplopia. [41][42] Recently, we reported on a modified 'swinging eyelid' approach for two-or three-wall orbital decompression in 19 patients with GO.…”

“…9,25 Therefore, we propose a new scoring system, which we use to calculate the incidence of induced diplopia in our series and in previously published series. [3][4][5][6][7][8][9][10][11][12][13]16,18,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39] …”

A morphometric study of the inferior orbital fissure using three‐dimensional anatomical landmarks: Application to orbital surgery

“…After extensive lateral wall resection, Goldberg et al (2000) found an average of 5.9 mm reduction in exophthalmos, which offers a reduction of 0-0.5 mm in proptosis for each cubic millimeter of orbital volume expansion because of its location (Gonzalez et al, 2002). It has also been reported that removal of up to 25 mm of the lateral wall of the orbital rim yields only 2-2.9 cc of volume (Hitotsumatsu and Rhoton, 2000;Unal et al, 2003;Beden et al, 2007). Baldeschi et al (2005) stated that removal of the lateral wall reduces exophthalmos by 2.3 mm, with a 13% incidence of new-onset diplopia, which usually resolves spontaneously in 4-6 months.…”

Complicações rinossinusais após descompressão orbital em técnica externa e endonasal combinada

“…9,14,15 Existe grande dificuldade em avaliar a presença de rinossinusite aguda após a cirurgia, pois os sintomas podem se confundir com os sintomas próprios do trauma causado pela cirurgia. Os exames de imagem em uma fase aguda tem pouca utilidade, uma vez que a presença de sangue e o edema prejudicam a avaliação.…”