Fat-removal orbital decompression for disfiguring proptosis associated with Graves’ ophthalmopathy: safety, efficacy and predictability of outcomes

Abstract

The objective of this study was to analyse clinical outcomes of patient who underwent fat-removal orbital decompression (FROD) for disfiguring proptosis associated with Graves' ophthalmopathy. This is a retrospective review of 21 eyes of 11 patients who have received transforniceal FROD for disfiguring Graves' exophthalmos at the Hong Kong Eye Hospital from January 2009 to March 2012. The amount of orbital fat removed and proptosis reduction in terms of Hertel value and complications were evaluated. The mean volume of orbital fat removed was 4.0 ± 1.1 ml (range 1.6-5.5 ml), and the mean change of Hertel value was 4.2 ± 1.3 (range 1-6, p < 0.000). None has visual loss or new-onset diplopia at primary gaze after FROD. No complications such as retrobulbar haemorrhage, meningitis, sinusitis, tissue necrosis, infraorbital paraesthesia or unsightly scar were observed. FROD could achieve reasonable proptosis reduction. It had a good safety profile, and results were predictable.

Long-term outcomes of orbital fat decompression in Graves’ orbitopathy

“…Our results demonstrated consistent long-term efficacy of orbital fat decompression in reducing proptosis of 4.1±1.3, 4.6±1.3 and 4.2±1.4 mm at 1–3, 3–5 and 5–10 years, respectively. These results were consistent with previous studies in which proptosis reduction ranged from 3 to 5.9 mm at 12,12 16,19 2217 and 3620 months follow-up. The amount of proptosis reduction for solely fat decompression in this study was also comparative with those of bony decompression with21 or without22 the endoscopic approach that reported 4 and 4.45 mm, respectively, in the long-term follow-up.…”

“…It has been suggested the larger amount of resected orbital fat may account for the higher rate of induced diplopia 10. This is further evidenced by lower diplopia occurrence in this (4.5±1.1 mL), our previous10 (3.6±1 mL) and others17 studies (4±1.1 mL) compared with 6.3 mL reported by Richter et al 12. The substantial impact of controlling the amount of resection of intraconal fat on the prediction of proptosis reduction demonstrated in the current study is consistent with our previous finding 10.…”

Fat-removal orbital decompression for thyroid associated orbitopathy: The right procedure for the right patient

“…In addition, there will be increase in the intraorbital pressure causing congestion and impedance of orbital venous outflow and restriction of extraocular motility leading to diplopia. Moreover, compressive optic neuropathy may develop in patients with severe forms of the disease 3, 4, 5, 6…”

Current trends in the management of thyroid eye disease

“…In a retrospective review, orbital fat removal alone (average 4.0 ml) significantly reduced exophthalmos by 4.2 mm in 21 patients [40]. However, exophthalmometry reduction is not just based on volume of fat removed; a cross-sectional study of 120 patients treated with fat removal suggests that exophthalmometry reduction relies on volume of fat removed, as well as age, sex, and the presence of preoperative diplopia [41].…”