Abstract
To evaluate the safety and efficacy of orbital decompression combined with strabismus surgery in thyroid-associated orbitopathy (TAO) and identify factors leading to surgical success. A retrospective comparative case series was conducted on 52 patients who were treated with combined orbital decompression and strabismus surgery. Outcome measurements included perioperative Hertel exophthalmometry and strabismus measurements. Surgical success was defined as binocular single vision (BSV) in the primary and reading positions within 5 prism diopters (PDs). As a result, the average reduction in proptosis was 3.23 mm, with a mean preoperative Hertel measurement of 22.64 mm. Forty-four patients (84.6%) achieved the success criterion and composed the success group. In addition to sex and underlying hyperthyroidism, symmetry of orbitopathy, interocular exophthalmos difference of more than 2 mm, predominant esotropia type, mixed type strabismus, baseline horizontal deviations, baseline vertical deviations, and combination with one-wall decompression surgery were significantly different between the success and failure groups. All complications were mild and temporary. Orbital decompression combined with strabismus surgery produced satisfactory outcomes in selected patients with efficacy and safety. Symmetry between the two eyes with relatively simple strabismus and proptosis ensured surgical success. With experienced surgeons, advanced techniques, and selected patients, this method can serve as an alternative treatment option to minimize the number of surgeries, medical costs and recovery period.
Highlights
Thyroid-associated orbitopathy (TAO) is a complex disorder associated with autoimmunity against orbital tissues and is characterized by inflammation of retrobulbar tissues, adipogenesis, and the accumulation of glycosaminoglycans within the extraocular muscles [1]
A preoperative imaging study was performed for every patient with computed tomography scans (CT) to assess orbital crowding and muscle hypertrophy and aid in surgical planning
The p value in the table is from values compared between Group 1 and Group 2
Summary
Thyroid-associated orbitopathy (TAO) is a complex disorder associated with autoimmunity against orbital tissues and is characterized by inflammation of retrobulbar tissues, adipogenesis, and the accumulation of glycosaminoglycans within the extraocular muscles [1]. In 1986, Shorr and Seiff [6] proposed the staged approach in the surgical treatment of TAO patients: (1) orbital decompression, (2) extraocular muscle surgery, (3) eyelid margin repositioning, and (4) blepharoplasty. This approach has become a consensus and has been carried out for most TAO patients requiring surgical intervention. A wide variety of surgical techniques have been introduced and improved over the years, and the rate of patients undergoing orbital decompression for TAO has increased substantially [10]. Current indications for surgery have become broad, from cases of optic neuropathy to extreme corneal exposure to cosmetic rejuvenation, and surgical techniques are often individualized for different cases [12,13,14]
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