Image- guided balanced orbital decompression for the management of thyroid eye disease: An analysis of outcomes and complications

Abstract

Background: Thyroid eye disease (TED) commonly presents with proptosis, lid retraction, and diplopia. Multiple surgical techniques have been described to rehabilitate the orbit and to restore vision. Balanced orbital decompression is advocated as a standard surgical technique, and image guidance is encouraged to minimize surgical risks. We evaluated the outcomes of patients who underwent image- guided balanced three walls orbital decompression for TED. Methods: An IRB approved retrospective chart review study was performed on all patients who underwent image-guided balanced orbital decompression between January 2010 and December 2016 at West Virginia University Hospital. Demographics, pre-operative and post-operative clinical data including indications, presence of pre- and post-operative diplopia, and exophthalmometry were abstracted. Results: 169 orbital decompressions in 103 patients were performed. The mean age was 56 years, and the prevalence of pre-operative diplopia was 73%. The incidence of new- onset post-operative diplopia was 5.8%. Among patients who had pre-operative diplopia, 48% had resolution of their diplopia post- operatively. The mean reduction in proptosis was 4.7 mm. No patient experienced intraoperative and/ or postoperative complications. Conclusion: Image-gulded balanced lateral, medial and inferior orbital decompression can result in improvement of visual aculty and resolution of pre- existing .diplopia while allowing for significant reduction in proptosis.