Strabismus After Balanced Medial Plus Lateral Wall Versus Lateral Wall Only Orbital Decompression for Dysthyroid Orbitopathy

Abstract

Lateral wall orbital decompression may produce less new-onset, persistent postoperative strabismus than balanced medial plus lateral wall orbital decompression for dysthyroid orbitopathy.

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

“…22 In 16 studies on transconjunctival, transcaruncular, and translid decompression, the reported incidence of NOD ranged from 0 25 to 33%. 31 In one of these studies, 28 the reported incidence of NOD was 9% vs a recalculated value of 25%. In five other studies, a combined transnasal and translid/transconjunctival approach was used, with a reported incidence of NOD ranging from 0 34,35 to 12%.…”

“…18 Recalculation of data from studies on anterior approach three-wall orbital decompression, including translid, transconjunctival ('swinging eyelid'), and coronal techniques show relatively low NOD frequencies of 0 to 33% (Table 6). Although it was speculated that a 'balancing effect' of lateral and medial wall decompression may limit the frequency of NOD, 7,24,26,31,35,38 recent studies 25,30 failed to show a difference between translid or transconjunctival two-wall decompression and coronal three-wall decompression in that respect.…”

“…In a recent retrospective and nonrandomized study, 31 31 patients underwent orbital decompression with either removal of the lateral and medial wall or removal of the lateral wall combined with excision of intraconal orbital fat. The authors concluded that the latter procedure lowers the risk of NOD from 33 to 7%.…”

“…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.…”

“…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] …”