Endoscopically controlled surgical decompression of the orbit in malignant ophthalmopathy

Abstract

From May 1988, an endoscopically controlled endonasal orbital decompression was performed in 17 patients with malignant ophthalmopathy. Indications were exclusively acute loss of visual acuity or visual field defects, when medical and radiation therapy had failed. The new minimal invasive technique proceeds in three steps. First, an endonasal, endoscopically controlled ethmoidectomy with resection of the middle turbinate is done and the medial wall of the maxillary sinus is widely opened. Second, the medial and inferior orbital walls are removed, preserving the infraorbital nerve. In the last step, the periorbita is incised and the orbital fat herniates. The advantages of this procedure consist of the absence of exterior scars, the avoidance of lacrimal duct stenosis and bony defects in the maxilla and the prevention of the known morbidity of a Caldwell-Luc antrotomy with hypesthesia, dysesthesia and oro-antral fistula. The results were documented by computerized tomographic scans (CT), magnetic resonance imaging (MRI), Hertel measurements, evaluation of ocular motility and ophthalmoscopy. All patients had a postoperative improvement of visual acuity. An average of 3-4 mm improvement in Hertel measurements was reached. Four patients who had a diplopia before the interventions developed a more significant diplopia postoperatively, whereas in all other patients ocular motility either improved (five patients) or remained the same. In conclusion, the endoscopically controlled endonasal procedure enables greater preservation of normal structures and provides results comparable with the common extranasal and transantral procedures without the disadvantages of the latter.