En bloc resection of the lateral orbital rim to reduce exophthalmos in patients with Graves' disease

Schaaf, Helmut; Santo, Gregor; Gräf, Michael; Howaldt, Hans‐Peter

doi:10.1016/j.jcms.2009.04.001

Cited by 10 publications

(7 citation statements)

References 34 publications

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“…The fact that vertical deviation was equally affected as horizontal deviation indicates that the underlying mechanism relates more to the vulnerability of extraocular muscle balance than possible direct damage to the lateral rectus muscle itself. In line with our findings and using the same surgical technique, Schaaf et al found an improvement in preexisting strabismus in 14% of their patients and new-onset diplopia in 4.7% (one out of 21 patients) [ 14 ]. They found a slight worsening of eye motility on average by 2.4° on upgaze and 0.5° on lateral gaze.…”

Section: Discussionsupporting

confidence: 90%

“…Exophthalmos improved in all patients, complications encompassed postoperative bleeding and hypesthesia of the infraorbital nerve, and there was no flattening of the malar contour. Most recently, describing their results after two-wall inferolateral decompression in 44 patients, Schaaf et al [ 14 ] reported an average exophthalmos reduction of 3.8 mm, with one patient developing new-onset diplopia after surgery that required surgical correction.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the reported incidence rates of induced diplopia or worsening of motility after different other than lateral wall approaches for orbital decompression are generally higher than those with our technique. A literature review reveals worsening of binocular functions in 16–74% after inferomedial decompression [ 27 , 28 ], in up to 45% after balanced decompression [ 5 , 29 ], in 2.6–8% after rim-sparing (deep) lateral wall decompression [ 5 , 30 , 31 ], and in 0–5% after en blocresection of the lateral wall [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Results after En Bloc Lateral Wall Decompression Surgery with Orbital Fat Resection in 111 Patients with Graves’ Orbitopathy

Fichter¹,

Guthoff

2015

International Journal of Endocrinology

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Purpose. To evaluate the effect of en bloc lateral wall decompression with additional orbital fat resection in terms of exophthalmos reduction and complications. Methods. A retrospective, noncomparative case series study from 1999 to 2011 (chart review) in Graves' orbitopathy (GO) patients. The standardized surgical technique involved removal of the lateral orbital wall including the orbital rim via a lid crease approach combined with additional orbital fat resection. Exophthalmos, diplopia, retrobulbar pressure sensation, and complications were analyzed pre- and postoperatively. Results. A total of 111 patients (164 orbits) with follow-up >3 months were analysed. Mean exophthalmos reduction was 3.05mm and preoperative orbital pressure sensation resolved or improved in all patients. Visual acuity improved significantly in patients undergoing surgery for rehabilitative or vision threatening purposes. Preoperative diplopia improved in 10 patients (9.0%) but worsened in 5 patients (4.5%), necessitating surgical correction in 3 patients. There were no significant complications; however, one patient had slight hollowing of the temporalis muscle around the scar that did not necessitate revision, and another patient with a circumscribed retraction of the scar itself underwent surgical correction. Conclusions. The study confirms the efficiency of en bloc lateral wall decompression in GO in a large series of patients, highlighting the low risk of disturbance of binocular functions and of cosmetic blemish in the temporal midface region.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Results after En Bloc Lateral Wall Decompression Surgery with Orbital Fat Resection in 111 Patients with Graves’ Orbitopathy

Fichter¹,

Guthoff

2015

International Journal of Endocrinology

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“…Several studies have looked at the functional and esthetic outcomes when removing the lateral orbital rim as part of a primary lateral orbital decompression surgery. [ 2 3 4 5 6 7 ] These studies used different surgical techniques and showed a fairly wide range of proptosis reduction between studies, and conclusions were mixed. Sagiv et al .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of lateral orbital rim decompression in patients with prior rim-sparing, three-wall orbital decompression

Kikkawa

Lee

Kim

et al. 2022

Taiwan J Ophthalmol

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PURPOSE: The purpose was to study the effects of removal of the lateral orbital rim in patients with prior three-wall decompression for thyroid eye disease (TED). MATERIALS AND METHODS: This was a single-institution retrospective case series of patients presenting with symptoms and signs of residual symptomatic proptosis that had previously undergone three-wall decompression for TED. Data collected included patient age, gender, presenting symptoms, ocular history, proptosis reduction, and complications. RESULTS: Eleven orbits were identified. The mean preoperative exophthalmometry for the operative eye was 24.0 mm with 2.7 mm of relative proptosis. Removal of the lateral orbital rim resulted in a mean reduction in proptosis of 2.5 mm (range: 0.5–5.0 mm, P < 0.001). There was no significant change in diplopia, lagophthalmos, margin reflex distance (MRD) 1, MRD2, or exposure keratopathy. No canthal deformities were noted. All subjects reported satisfaction with functional and cosmetic outcomes of lateral orbital rim removal, and none reported problems with external contour irregularities of the lateral canthal region. CONCLUSION: Removal of the lateral orbital rim as part of a maximal orbital bony decompression adds to the decompressive effect of proptosis reduction with minimal side effects.

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“…Vários estudos mostram que a DLP apresenta menor índice de diplopia pósoperatória do que as técnicas de descompressão para os seios paranasais (Goldberg et al, 2000;Ben Simon et al, 2004;Liao et al, 2006;Chang;Piva, 2008;Schaaf et al, 2010;Mehta;Durrani, 2011;Gulati et al, 2015;Jefferis et al, 2018;Bengoa-Gonzalez et al, 2019). Essa variação pode ser explicada, tanto pelo fato de os músculos reto inferior e medial serem os mais afetados pela miopatia restritiva da OG quanto pela DIM remover o suporte ósseo a esses músculos e ao globo ocular.…”

Section: Deformação Do Músculo Reto Lateral E Oculomotricidadeunclassified

Descompressão lateral profunda na orbitopatia de Graves: deformação do músculo reto lateral, efeitos translacionais e rotacionais oculares

Caetano¹

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A Deus, por guiar, proteger e preencher minha vida com tantas bênçãos.Ao meu marido, por compreender minhas ausências e dificuldades ao longo deste estudo com carinho, apoio incondicional, leveza e amor.Aos meus filhos, no colo ou na barriga, por me darem força para sempre seguir em frente.Aos meus pais, que sempre fizeram o possível e o impossível para me dar asas e atingir meus sonhos.Aos meus irmãos, pela amizade leve e respeitosa e por sempre olharem para este projeto com carinho e admiração.

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En bloc resection of the lateral orbital rim to reduce exophthalmos in patients with Graves' disease

Cited by 10 publications

References 34 publications

Results after En Bloc Lateral Wall Decompression Surgery with Orbital Fat Resection in 111 Patients with Graves’ Orbitopathy

Results after En Bloc Lateral Wall Decompression Surgery with Orbital Fat Resection in 111 Patients with Graves’ Orbitopathy

Efficacy of lateral orbital rim decompression in patients with prior rim-sparing, three-wall orbital decompression

Descompressão lateral profunda na orbitopatia de Graves: deformação do músculo reto lateral, efeitos translacionais e rotacionais oculares

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