Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy

Abstract

Aim The purpose of this study is to share our experience on the use of different orbital decompression techniques, as well as the principles followed for deciding the most case-appropriate procedure that ensured the most favorable outcomes. Methods We reviewed the Graves’ ophthalmopathy cases operated over the course of 14 years, regarding the presenting signs, the imaging evaluation, the degree of exophthalmos, the type of surgical orbital decompression performed, and the postoperative outcomes. Results All 42 patients identified presented with proptosis, with 92.8% cases of bilateral proptosis. The main addressing concern was functional in 54.8% cases and aesthetic in 45.2% patients. CT was used for the preoperative evaluation in all cases. In total, 81 orbits were operated. The orbital decompression surgery involved only the orbital fat in 7.4% of orbits and associated fat and bone decompression in the other 92.6% of orbits. The postoperative results were favorable in all cases regarding both appearance and function, with minimal postoperative complications. Conclusion The adequate selection of the most suitable procedure based on the characteristics of each case is the prerequisite for a successful surgery. We found that the association of fat and bone decompression of various extents is most permissive in tailoring the degree of decompression to the existing requirements.

Spontaneous Dislocation of the Lens Nucleus Into the Anterior Chamber Observed in a Patient With Overmature Senile Cataract

“…Therefore, we temporarily excluded intraocular tumors, genetic factors, and systemic diseases and considered the patient’s economic status; no genetic examination was performed. For complete anterior dislocation of the lens, it is optimal to induce pupillary constriction and perform surgical removal of the dislocated lens 4 . The techniques employed for extracting the displaced lens primarily encompass extracapsular cataract extraction and phacoemulsification cataract extraction.…”

Endoscope-navigation-assisted orbital decompression for graves’ orbitopathy

“…16–18 An individualized decompression plan can be made according to anatomical measurements and variations in the orbit, which carries the promise of predictable decompression. 19, 20…”

“…[16][17][18] An individualized decompression plan can be made according to anatomical measurements and variations in the orbit, which carries the promise of predictable decompression. 19,20 During decompression surgery, the use of ENS allows the real-time, precise and three-dimensional identification of the resectable borderline of the orbital wall and provides the visualization of the surgical procedure especially in the deep orbit; therefore, vulnerable neurovascular bundles or other important structures can be protected, reducing the risk of iatrogenic injury and severe complications. CSF leakage is a rare, but potentially morbid complication in orbital decompression.…”

Graves hastalığı cerrahisinde güncel yaklaşımlar

“…Costan ve arkadaşlarının 42 toksik guatr'a bağlı oftalmopati olgusunda yaptıkları bir çalışmada; olguların %54 ünün fonksiyonel bozukluklar nedeniyle, %46 sının ise kozmetik nedenlerle opere edildiği, seçilecek operasyon tekniğinin her hastanın özelliğine göre belirlenmesi gerektiği bildirilmiştir 35 .…”