Balanced orbital decompression for graves' ophthalmopathy

Shepard, Kimberly; Levin, Peter S.; Terris, David J.

doi:10.1097/00005537-199811000-00011

Cited by 87 publications

(64 citation statements)

References 25 publications

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“…11,22 As techniques for orbital decompression have advanced, the minimal morbidity from surgery has meant that an increasing number of patients are now requesting intervention for purely cosmetic reasons. 1,23,24 In this series and others endoscopic decompression of the medial orbital wall and oor gives reasonable proptosis reduction with minimal morbidity and, therefore, should be considered as a treatment option.…”

mentioning

confidence: 59%

Endoscopic orbital decompression for Graves’ ophthalmopathy

Wee¹,

Carney²,

Thorpe³

et al. 2002

J. Laryngol. Otol.

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Graves' disease may occasionally result in signi cant proptosis that is either cosmetically unacceptable or causes visual loss. This has traditionally been managed surgically by external decompression of the orbital bony skeleton. Trans-nasal endoscopic orbital decompression is emerging as a new minimally-invasive technique, that avoids the need for cutaneous or gingival incisions. Decompression of the medial orbital wall can be performed up to the anterior wall of the sphenoid sinus. This can be combined with resection of the medial and posterior portion of the orbital oor (preserving the infra-orbital nerve). This technique produces decompression which is comparable to external techniques.We present a series of 10 endoscopic orbital decompressions with an average improvement of 4.4.mm in orbital proptosis. There was an improvement in visual acuity in all patients with visual impairment. Endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques.

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mentioning

confidence: 59%

Endoscopic orbital decompression for Graves’ ophthalmopathy

Wee¹,

Carney²,

Thorpe³

et al. 2002

J. Laryngol. Otol.

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“…This technique was reported to be associated with a greater reduction of proptosis and lower prevalence of postoperative diplopia compared with the transantral technique (138). It was observed that balancing the decompression and preserving the medial orbital strut between the ethmoid sinus and the orbital floor may minimize the risk of postoperative diplopia (144). In a large, retrospective study (138), the mean decrease in proptosis was 4.3 mm (range 0 -10 mm), the largest reduction being observed in those patients who had the highest (Ͼ27 mm) preoperative Hertel readings.…”

Section: Orbital Decompressionmentioning

confidence: 99%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper-and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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“…[1][2][3][4][5][6] The mainstay of treatment has been two wall decompression originally described by Walsh and Ogura 4 in 1957, modified into an endoscopic formulation by Kennedy in 1990. 7 Although inferomedial orbital decompression has afforded good results in terms of proptosis reduction, it accrues a large risk of postoperative diplopia, with rates of postoperative motility imbalance as high as 80%.…”

Section: Introductionmentioning

confidence: 99%

“…8 In fact, even with the creation of a strut at the ethmoid-maxillary junction, two wall decompression still carries such a high risk of postoperative diplopia 9,10 that some surgeons do not even consider it to be a complication. 11 Alternative techniques have been sought in an attempt to decrease decompression-induced diplopia; 1 Graham et al 12 suggested a balanced decompression that requires lateralization of the outfractured lateral wall, whereas the lateral orbital wall has recently been suggested as the region of first choice for orbital decompression as it provides a low risk of consecutive diplopia or severe complications, such as cerebrospinal fluid leak. 13 Despite the wide variety of innovative approaches designed by multidisciplinary teams, orbital decompression remains a technically challenging procedure where the goal of proptosis reduction competes with postoperative diplopia and cosmetic requests of an increasingly demanding patient population.…”

Section: Introductionmentioning

confidence: 99%

The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy

Millar

Maloof

2009

Eye

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Objectives To describe the application of stereotactic guidance, its preoperative workup, and limitations, if any, during orbital decompression surgery of the lateral orbital wall for thyroid-associated orbitopathy (TAO). Methods Case-controlled series of seven patients who underwent stereotactic-guided surgical navigation during external approach balanced orbital decompression with maximal debulking of the lateral wall. Results A progressive increase in debulking of the greater wing of sphenoid and exposure of dura was noted in the series. The average proptosis reduction was 9.36 mm. No complications were encountered during any of the cases, nor was there any new onset postoperative diplopia. In all cases, exposure of dura was planned and did not present as a surprise. Stereotactic setup added 10 min to preparation time. Conclusions Stereotactic guidance improves anatomic localization and precision during orbital decompression, increasing confidence, and reducing surgical stress. The ability to accurately determine the maximal limits of decompression real time, while confirming depth of bone removal, offers the possibility of reduced risk of iatrogenic injury. Stereotactic navigation allows for improved intraoperative localization that may improve the ability to maximally decompress the lateral wall, including the zygoma, orbital roof, and trigone, and extending towards the optic nerve with exposure of dura through smaller incisions.

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Balanced orbital decompression for graves' ophthalmopathy

Cited by 87 publications

References 25 publications

Endoscopic orbital decompression for Graves’ ophthalmopathy

Endoscopic orbital decompression for Graves’ ophthalmopathy

Management of Graves' Ophthalmopathy: Reality and Perspectives

The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy

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