Orbital decompression for thyroid eye disease: methods, outcomes, and complications

Abstract

PurposeTo determine the safety and effectiveness of orbital decompression for thyroid eye disease (TED) in our unit. To put this in the context of previously published literature.Patients and methodsA retrospective case review of all patients undergoing orbital decompression for TED under the care of one orbital surgeon (SMS) between January 2009 and December 2015. A systematic literature review of orbital decompression for TED.ResultsWithin the reviewed period, 93 orbits of 55 patients underwent decompression surgery for TED. There were 61 lateral (single) wall decompressions, 17 medial one-and-a-half wall, 11 two-and-a-half wall, 2 balanced two wall, and 2 orbital fat only decompressions. For the lateral (single) wall decompressions, mean reduction in exophthalmometry (95% confidence interval (CI) was 4.2 mm (3.7-4.8), for the medial one-and-a-half walls it was 2.9 mm (2.1-3.7), and for the two-and-a-half walls it was 7.6 mm (5.8-9.4). The most common complications were temporary postoperative numbness (29% of lateral decompressions, 17% of other bony decompressions, OR 0.50, 95% CI 0.12-2.11) and new postoperative diplopia (9% of lateral decompressions, 39% of other bony decompressions, OR 6.8, 95% CI 1. 5-30.9). Systematic literature searching showed reduction in exophthalmometry for lateral wall surgery of 3.6-4.8 mm, with new diplopia 0-38% and postoperative numbness 12-50%. For other bony decompressions, reduction in exophthalmometry was 2.5-8.0 mm with new diplopia 0-45% and postoperative numbness up to 52%.ConclusionDiffering approaches to orbital decompression exist. If the correct type of surgery is chosen, then safe, adequate surgical outcomes can be achieved.

Endoscopic orbital decompression in Graves ophthalmopathy - Case report

“…There are studies which report endoscopic approaches with an average of 1 to 8 mm reduction of proptosis with an endoscopic decompression of the medial wall, medial one-and-a-half wall, three wall, orbital apex 8 . This happens when there is no improvement from immunosuppressive therapy and radiotherapy, and when patients have an increased risk of dysthyroid optic neuropathy 9 .…”

“…One aspect to be mentioned to the patients is that after surgery they are prone to the activation of other inflammatory or autoimmune diseases. This is why perioperative intravenous methylprednisolone is taken into consideration as well as close monitoring in the early postoperative period 8 . …”

Principles of Protection of the Eye and Vision in Orbital Surgery

“…Potential complications include corneal dryness secondary to intraoperative exposure, direct ocular injury leading to corneal abrasions or perforations, eyelid malposition including ectropion, entropion, or retraction, globe malposition such as enophthalmos or hypoglobus, infection or exposure of implanted synthetic materials, postoperative diplopia, and postoperative hypesthesia. 7,8 The incidence and type of complication vary depending on the type of orbital procedure performed. In a retrospective review of 93 orbits undergoing orbital decompression for thyroid eye disease, Jefferis et al found the most common complications to be temporary postoperative hypesthesia (29% of lateral decompressions, 17% of others) and new postoperative diplopia (9% of lateral decompressions, 39% of others).…”

“…In a retrospective review of 93 orbits undergoing orbital decompression for thyroid eye disease, Jefferis et al found the most common complications to be temporary postoperative hypesthesia (29% of lateral decompressions, 17% of others) and new postoperative diplopia (9% of lateral decompressions, 39% of others). 7 Postoperative diplopia can occur after any orbital surgery secondary to extraocular muscle transection or contusion, cranial nerve impairment, muscle or fat incarceration, or fascial scarring. 9 New-onset diplopia with orbital decompression can occur due to the altered shape of the orbit and secondary effect on the course of the extraocular muscles.…”

Thyroid Eye Disease Simplified

“…The prime questions are: 1 In mild eyelid retraction, the eyelid is positioned at the limbus, in moderate eyelid retraction, the eyelid is positioned up to 2 mm above limbus and in severe eyelid retraction; In a couple of patients, thyroidectomy helped reduce the thyroid antibody levels and thus helped control TED.…”