Results of Transantral Orbital Decompression in 428 Patients With Severe Graves' Ophthalmopathy

The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy

“…7 In the demand for small incision surgery in modern day surgical era, recent trends have been towards both anaesthetically insignificant incisions and endoscopic approaches, although concurrently reducing the incidence of postoperative diplopia and iatrogenic injury. [6][7][8][9][10][11][12][13][14][15] With the advent of smaller incision orbital surgery, perspective and localization becomes increasingly difficult and may pose a limitation against maximal decompression. However, even when good exposure of the floor is obtained through the transorbital approach reported by McCord 21 and Anderson and Linberg, 22 the medial wall view can occasionally be difficult, particularly with bleeding in the crucial area of the orbital apex, with potentially unpleasant consequences for both clinicians and patients.…”

“…7 Although inferomedial orbital decompression has afforded good results in terms of proptosis reduction, it accrues a large risk of postoperative diplopia, with rates of postoperative motility imbalance as high as 80%. 8 In fact, even with the creation of a strut at the ethmoid-maxillary junction, two wall decompression still carries such a high risk of postoperative diplopia 9,10 that some surgeons do not even consider it to be a complication. 11 Alternative techniques have been sought in an attempt to decrease decompression-induced diplopia; 1 Graham et al 12 suggested a balanced decompression that requires lateralization of the outfractured lateral wall, whereas the lateral orbital wall has recently been suggested as the region of first choice for orbital decompression as it provides a low risk of consecutive diplopia or severe complications, such as cerebrospinal fluid leak.…”

Efficacy and side effects of ‘swinging eyelid’ orbital decompression in Graves' orbitopathy: a proposal for standardized evaluation of diplopia

“…In 11 studies on transantral decompression, the reported incidence of NOD ranged from 22 9 to 73%. 14 After recalculation, the incidence ranged from 64 to 73%.…”

“…1 Transantral as well as transnasal orbital decompression have been reported to induce diplopia in up to 73% of patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] After translid, transconjunctival, transcaruncular, [21][22][23][24][25][26][27][28][29][30] and coronal orbital decompression, 25,[30][31][32][33] as well as after combinations of these techniques, [34][35][36][37][38][39][40] diplopia was observed less frequently, while orbital fat removal seems to carry the lowest risk of inducing diplopia. [41][42] Recently, we reported on a modified 'swinging eyelid' approach for two-or three-wall orbital decompression in 19 patients with GO.…”

“…This is hampered by the lack of a uniform scoring system. 9,25 Therefore, we propose a new scoring system, which we use to calculate the incidence of induced diplopia in our series and in previously published series. [3][4][5][6][7][8][9][10][11][12][13]16,18,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39] …”