Original endoscopic orbital decompression of lateral wall through hairline approach for Graves’ ophthalmopathy: an innovation of balanced orbital decompression

Abstract

BackgroundOrbital decompression is an important surgical procedure for treatment of Graves’ ophthalmopathy (GO), especially in women. It is reasonable for balanced orbital decompression of the lateral and medial wall. Various surgical approaches, including endoscopic transnasal surgery for medial wall and eye-side skin incision surgery for lateral wall, are being used nowadays, but many of them lack the validity, safety, or cosmetic effect.Patients and methodsEndoscopic orbital decompression of lateral wall through hairline approach and decompression of medial wall via endoscopic transnasal surgery was done to achieve a balanced orbital decompression, aiming to improve the appearance of proptosis and create conditions for possible strabismus and eyelid surgery afterward. From January 29, 2016 to February 14, 2017, this surgery was performed on 41 orbits in 38 patients with GO, all of which were at inactive stage of disease. Just before surgery and at least 3 months after surgery, Hertel’s ophthalmostatometer and computed tomography (CT) were used to check proptosis and questionnaires of GO quality of life (QOL) were completed.FindingsThe postoperative retroversion of eyeball was 4.18±1.11 mm (Hertel’s ophthalmostatometer) and 4.17±1.14 mm (CT method). The patients’ QOL was significantly improved, especially the change in appearance without facial scar. The only postoperative complication was local soft tissue depression at temporal region. Obvious depression occurred in four cases (9.76%), which can be repaired by autologous fat filling.InterpretationThis surgery is effective, safe, and cosmetic. Effective balanced orbital decompression can be achieved by using this original and innovative surgery method. The whole manipulation is safe and controllable under endoscope. The postoperative scar of endoscopic surgery through hairline approach is covered by hair and the anatomic structure of anterior orbit is not impacted.

Evaluation of the Graves’ Orbitopathy-Specific Quality of Life Questionnaire in the Mainland Chinese Population

“…[8] Many studies showed that the GO-QOL is used as an indicator to assess the improvement in GO patients after suitable treatment. [10, 13, 14] We deduced that the GO-QOL was an efficient instrument to evaluate patients with GO.…”

The Outcomes of Balanced Orbital Decompression for Dysthyroid Optic Neuropathy: Focusing on Choroiretinal Folds with and without Optic Disc Edema

“…The greater wing of the sphenoid bone was removed, and additional removal of the anterior department of the inferior orbital fissure was performed in most patients. Medial wall orbital decompression was performed much the same as previously described by an otolaryngologist (Peng Tian) using a transnasal endoscopic approach [ 15 ]. The procedures were as follows: (1) incise and excise the uncinate process.…”

Efficacy of selenium supplementation for mild-to-moderate Graves’ ophthalmopathy in a selenium-sufficient area (SeGOSS trial): study protocol for a phase III, multicenter, open-label, randomized, controlled intervention trial

“…The GO-QOL created by Terwee et al [38] is a useful modality to measure quality of life among patients with GO and has been validated in several studies performed in various regions [38][39][40][41]. Due to its high association with disease activity and treatment response [42][43][44][45][46], the European Group on Graves' Orbitopathy has recommended the use of the GO-QOL as an evaluation tool in clinical trials [47]. The GO-GOL consists of two subscales: visual functioning and appearance.…”