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Abstract

We thank Dr Perry for his comments on our article about transcaruncular orbital decompression. He pointed out the successful treatment of dysthyroid compressive optic neuropathy using transcaruncular inferomedial wall decompression both in their previously published article 1 Perry J.D. Kadakia A. Foster J.A. Transcaruncular orbital decompression for dysthyroid optic neuropathy. Ophthalmol Plast Reconstr Surg. 2003; 19: 353-358 Crossref Scopus (48) Google Scholar and our present reported results. 2 Liao S.L. Chang T.C. Lin L.L. Transcaruncular orbital decompression: an alternate procedure for Graves ophthalmopathy with compressive optic neuropathy. Am J Ophthalmol. 2006; 141: 810-818 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar Even the orbital anatomy is quite different between Asian and Caucasian groups. Both studies had similar rates and degree of improvement after transcaruncular orbital decompression, but a higher rate of new-onset diplopia in our present study. The higher rate of induced diplopia may be attributable to more severe compressive optic neuropathy with multiple muscles enlargement as well as smaller and tighter orbits accompanied with extensive orbital bony defect in the Asian group. We agree that transnasal endoscopic orbital decompression can effectively treat dysthyroid compressive optic neuropathy and allow for simultaneous extraocular muscle surgery. While transcaruncular approach may provide better preservation of the anterior maxilloethmoidal strut to minimize consecutive diplopia, it also can allow for simultaneous extraocular muscle surgery, if we want. However, we prefer to perform extraocular muscle surgery three to six months after decompression surgery because it is hard to predict the effect of postoperative muscle restriction during decompression surgery. Further studies should be performed before we can draw a final conclusion. Transcaruncular Orbital Decompression: An Alternate Procedure for Graves Ophthalmopathy with Compressive Optic NeuropathyAmerican Journal of OphthalmologyVol. 142Issue 5PreviewIn the article entitled, “Transcaruncular Orbital Decompression: An Alternate Procedure for Graves Ophthalmopathy with Compressive Optic Neuropathy”,1 Dr Liao and associates confirmed our previously published results showing successful treatment of dysthyroid compressive optic neuropathy using transcaruncular approach medial and inferior wall orbital decompression.2 They found a similar rate and degree of improvement after transcaruncular approach decompression and a similar rate of new onset diplopia. Full-Text PDF