Proposing a Surgical Algorithm for Graduated Orbital Decompression in Patients with Graves' Orbitopathy

Overview

Journal Eur Arch Otorhinolaryngol

Specialty Otorhinolaryngology

Date 2021 Jul 22

PMID 34291345

Citations 5

Authors

Kerstin Stahr

Anke Daser

Michael Oeverhaus

Timon Hussain

Stephan Lang

Anja Eckstein

Stefan Mattheis

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the outcome after orbital decompression using a graduated technique, adapting the surgical technique according to individual patients' disease characteristics.

Methods: We retrospectively examined the postoperative outcome in patients treated with a graduated balanced orbital decompression regarding reduction of proptosis, new onset diplopia and improvement in visual function. 542 patients (1018 orbits) were treated between 2012 and 2020 and included in the study. Clinical examinations including visual acuity, exophthalmometry (Hertel) and orthoptic evaluation were performed preoperatively and at minimum 6 weeks postoperatively. Mean follow-up was 22.9 weeks.

Results: Mean proptosis values have significantly decreased after surgery (p < 0.01). In 83.3% of the patients Hertel measurement normalized (≤ 18 mm) after surgery, New onset diplopia within 20° of primary position occurred in 33.0% of patients, of whom 16.0% had preoperative double vision in secondary gaze. Patients suffering from dysthyroid optic neuropathy (DON) had a significant increase in visual acuity (p < 0.01).

Conclusion: We demonstrated that individually adapted graduated orbital decompression successfully improves key disease parameters of Graves' orbitopathy with low morbidity.

Citing Articles

Comparative effectiveness of various orbital decompression techniques in treating thyroid-associated ophthalmopathy: a systematic review and meta-analysis.

Guo W, Geng J, Li D BMC Ophthalmol. 2024; 24(1):526.

PMID: 39696149 PMC: 11653804. DOI: 10.1186/s12886-024-03749-3.

[Graves' orbitopathy as the cause of diplopia in old age-Differences between young and old].

Oeverhaus M, Neumann I, Chen Y, Eckstein A Ophthalmologie. 2024; 121(7):548-553.

PMID: 38922402 DOI: 10.1007/s00347-024-02073-x.

Balanced medial-lateral wall vs selective 3-wall orbital decompression for sight-threatening Graves's orbitopathy: a clinical retrospective cohort study from 2016 to 2022.

Tian P, Zeng P, Zhang H, Liang J, Li E, Ma Y Eur Arch Otorhinolaryngol. 2024; 281(9):4807-4815.

PMID: 38613579 DOI: 10.1007/s00405-024-08589-x.

How Age Affects Graves' Orbitopathy-A Tertiary Center Study.

Oeverhaus M, Sander J, Smetana N, Bechrakis N, Inga N, Al-Ghazzawi K J Clin Med. 2024; 13(1).

PMID: 38202297 PMC: 10779662. DOI: 10.3390/jcm13010290.

Update on the surgical management of Graves' orbitopathy.

Baeg J, Choi H, Kim C, Kim H, Jang S Front Endocrinol (Lausanne). 2023; 13:1080204.

PMID: 36824601 PMC: 9941741. DOI: 10.3389/fendo.2022.1080204.

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