Decompression In Graves Research Articles

Superior orbital fissure syndrome after deep lateral orbital wall decompression in Graves’ ophthalmopathy

ABSTRACT Purpose The superior orbital fissure contains cranial nerves III, IV, VI, and V1 with their three branches: frontal, lacrimal, and nasociliary. Superior orbital fissure syndrome (SOFS) is rare and can occur as a result of compression of these nerves due to trauma, bleeding, or inflammation in the retrobulbar space, but no cases of SOFS after deep lateral orbital wall decompression (DLOWD) have been reported. The aim of this paper is to describe this pathology, its possible causes, management, and outcome. Methods Retrospective study of 575 DLOWD in patients with disfiguring exophthalmos due to Graves’ ophthalmopathy performed in our hospital between 2010 and 2023. Three cases of postoperative SOFS were identified based on clinical presentation, history, physical examination, and radiological study. All patients were observed for a minimum of 12 months. Results SOFS was diagnosed with the presence of ophthalmoplegia, ptosis, fixed and dilated pupils, hypo/anesthesia of the upper eyelid and forehead, loss of corneal reflex, and no loss of vision after DLOWD. Fractures, edema, and hemorrhages were excluded. They were treated with high-dose intravenous steroids and the patients recovered completely. Conclusions DLOWD challenges orbital surgeons because it requires removing bones near the globe or neurovascular structures. SOFS may occur due to the proximity and increased pressure on these structures.

Long-term outcomes of inferomedial orbital wall decompression in Graves' ophthalmopathy in an Asian population: A 30-year retrospective study.

This study aims to evaluate the long-term outcomes of inferomedial orbital wall decompression (IMOD) in Graves' ophthalmopathy (GO). A retrospective review of 422 eyes of 226 patients with GO-related cosmetically disfiguring proptosis (COS), dysthyroid optic neuropathy (DON), or exposure keratopathy (EXP) who received IMOD from 1989 to 2020 was conducted. Hertel value (HE) and corrected visual acuity (CVA) were evaluated at baseline and regularly thereafter. Proptosis recurrence, diplopia, and adjuvant surgeries were assessed. Complete success was defined as proptosis reduction over 2 mm without recurrence and improved diplopia. Partial success was defined as proptosis reduction without recurrence but with persistent or new-onset diplopia, and failure as proptosis recurrence. After follow-up for 40.1 ± 39.6 months (range, 6-239 months), 236 eyes (55.9%) achieved complete success, 175 eyes (41.5%) achieved partial success, and 11 eyes (2.6%) had failure. Significant CVA improvement was observed in both DON and COS groups (P < 0.001 and P = 0.045, respectively). Average proptosis reduction was 5.2 ± 2.2 mm, with a significant increase of 0.5 mm after long-term follow-up (P < 0.001). Incidence of proptosis recurrence was 2.6%. Surgical success rate of COS group was positively correlated with preoperative HE. IMOD demonstrated excellent success rate in all three subgroups with a low proptosis recurrence rate and improved visual outcome in both DON and COS groups. Delayed proptosis reduction effect of IMOD may result in delayed-onset asymmetry, especially in the unilateral group.

Preoperative Risk Factors for Proptosis Recurrence After Rehabilitative Orbital Decompression in Graves’ Orbitopathy Patients

PurposeRehabilitative orbital decompression treats disfiguring exophthalmos in Graves’ orbitopathy (GO) patients. This study aimed to identify risk factors associated with the postoperative recurrence of proptosis after orbital decompression. DesignRetrospective case-control study MethodsThis retrospective review included patients with GO who underwent rehabilitative orbital decompression for disfiguring proptosis in an inactive state with a low clinical activity score (0-2) between Jan 2017 and Dec 2020 by a single surgeon. Exophthalmos was measured using a Hertel exophthalmometer, and recurrence was defined as an increase of 2 mm or more after decompression during the follow-up period. The association between preoperative variables and proptosis recurrence was analyzed using multivariable logistic regression. ResultsOf the total 217 patients, eleven (5.1%) developed recurrence of proptosis during the follow-up period (range 3-30, mean 15.6 months). Univariate logistic regression analysis identified thyroid-stimulating hormone receptor antibody (TRAb) and thyroid-stimulating immunoglobulin (TSI) as significant factors for recurrence with age, sex, smoking, disease duration, orbital radiotherapy, and total thyroidectomy history being non-significant. TRAb remained significant in a multivariate logistic regression analysis (OR 1.06; p=0.014). Receiver operating characteristic (ROC) curve analysis revealed an area under curve 0.86 with a sensitivity 90.9% and specificity 82.0% at TRAb level 7.96 IU/L. ConclusionPreoperative TRAb and TSI are valuable markers to predict proptosis recurrence after orbital decompression. These results may help surgeons to decide the optimal timing for orbital decompression to lessen the risk of postoperative recurrence of proptosis.

Comparison of the effects of orbital decompression in Graves' ophthalmopathy

Abstract Introduction Graves' disease is an autoimmune disorder. One of the symptoms is an overgrowth of the soft tissues of the orbit. Orbital involvement can cause exophthalmos, diplopia, or vision loss. Treatment strategies include a surgical approach that limits the ailments mentioned above. Decompression can be achieved by reducing the amount of enlarged tissues (fat removal) or increasing the space for enlarged tissues (bone removal). Numerous authors discuss the advantages and disadvantages of various techniques in terms of reducing the exophthalmos, the number and persistence of complications, and the long-term prognosis. Materials and Methods A literature search of PubMed and the Poznan University of Medical Sciences Main Medical Library resources from 1993–2022 was performed. Thirty articles were reviewed with attention to the surgical treatment of Graves' ophthalmopathy. Results The main surgical techniques include fat decompression and bone wall decompression. The results of exophthalmos fat removal are characterized by a significant decrease in proptosis (5.45mm) with a small percentage of newly formed diplopia (9%). Bone reduction in the lateral wall of the orbit shows similar effects: reducing exophthalmos (4.33mm) and the newly formed diplopia, as with fat removal (3.7%). Bone reduction in the medial- lateral wall, medial- inferior- lateral wall, and medial–inferior wall shows a decrease in proptosis ( 4.9 mm, 4.6 mm, 3.77 mm) and a higher percentage of new-onset diplopia (18%, 15%, 28%). Conclusion The smallest amount of newly formed diplopia at the highest proptosis reduction occurs with the self-removal of fat or resection of the lateral orbital wall.

Increased Orbital Muscle Fraction Diagnosed by Semi-Automatic Volumetry: A Risk Factor for Severe Visual Impairment with Excellent Response to Surgical Decompression in Graves' Orbitopathy.

Graves’ orbitopathy (GO) leads to increased orbital tissue and causes symptoms such as exophthalmos, functional complaints, or dysthyroid optic neuropathy. Different GO types with fat and/or muscle enlargement were identified, and increased muscle appears to particularly influence visual status and treatment response. The current study examines visual parameters dependent on orbital muscle volume fraction in a surgically treated GO cohort. After volumetric analysis of the preoperative orbital content, 83 orbits in 47 patients were categorized into predefined groups (increased or not-increased muscle fraction). All cases underwent pterional orbital decompression, and pre- and postoperative visual status was retrospectively analyzed. Forty-one orbits revealed increased and 42 orbits revealed not-increased muscle volume (mean fraction 29.63% versus (vs.) 15.60%). The preoperative visual acuity (VA) was significantly lower in orbits with increased vs. not-increased muscle volume (mean VA 0.30 vs. 0.53, difference 2.5 lines). After surgery, mean VA improved significantly by 1.7 lines in orbits with increased muscle volume. Not preoperative, but postoperative exophthalmos was significantly lower in orbits with not-increased muscle volume. Increased orbital muscle is associated with significantly reduced VA, but can be remarkably improved by pterional orbital decompression. Therefore, surgical therapy should be considered particularly in decreased VA with orbital muscle enlargement.

Ocular motility changes after inferomedial wall and balanced medial plus lateral wall orbital decompression in Graves' orbitopathy: a randomized prospective comparative study

OBJECTIVES:To compare the surgical outcomes of inferomedial wall orbital decompression (IM-OD) and balanced medial plus lateral wall orbital decompression (ML-OD) in patients with inactive Graves’ orbitopathy (GO) with regard to exophthalmos reduction and ocular motility abnormalities.METHODS:Forty-two patients with inactive GO eligible for OD were randomly assigned to either the IM-OD or ML-OD groups. Pre and postoperative evaluations included Hertel exophthalmometry, sensory, and motor extraocular motility assessment, standardized photographs in the nine gaze positions, and computed tomography (CT) of the orbits. ClinicalTrials.gov: NCT03278964.RESULTS:Exophthalmometry reduction was statistically significant in both groups (p<0.001), but was greater in the ML-OD group (p=0.010). New-onset esotropia occurred in 11.1% and 23.5% of patients who underwent IM-OD and ML-OD, respectively, with no statistically significant difference in the frequency of pre and postoperative strabismus in either group. The mean increase in preoperative esotropia was 24±6.9 and 12±8.8 prism diopters in patients who underwent IM-OD and ML-OD, respectively. In the IM-OD group, abduction and elevation worsened at the first (p<0.05) and third (p<0.05) postoperative visits but were restored at 6 months. The versions did not change postoperatively with ML-OD. The preoperative CT-measured medial rectus muscle area predicted new-onset strabismus (p=0.023). Significant postoperative medial rectus muscle enlargement occurred in both groups (p<0.001). Restriction in elevation and abduction was significantly associated with enlarged inferior (p=0.007) and medial rectus muscle areas (p=0.002).CONCLUSIONS:IM-OD is as safe as ML-OD with regard to new-onset strabismus, and represents a good alternative for patients who do not require significant exophthalmos reduction. ML-OD offers greater exophthalmos reduction and smoother postoperative recovery. Patients with preoperative enlarged medial rectus muscle on CT are at risk for new-onset esotropia, and preoperative esotropia is likely to increase after OD.

Impact of the ethmoid volume on endoscopic medial wall decompression outcomes in Graves’ orbitopathy

Background Endoscopic orbital decompression is a well-established technique for Graves orbitopathy treatment. Aims Measurement of the ethmoid volume and its correlation with proptosis reduction in patients undergoing endoscopic orbital decompression for Graves’ orbitopathy. Methods We retrospectively reviewed clinical charts of 209 patients (319 orbits) operated by a surgeon at our institution between 1998 and 2019. Results Average age was 46.9 years. About 83.3% of the patients were female, 54.6% were smokers, 93.8% were euthyroid at the time of decompression, 3.8% were hypothyroid and 2.4% were hyperthyroid. About 77.5% of the patients underwent bilateral surgery, the remainder and unilateral. Subsequent stages included strabismus surgery in 22.5% patients, Müllerectomy 37.8%, with or without canthoplasty (14.8 vs. 23%). Mean proptosis reduction was 4.61 mm. Mean ethmoid volume was 5.57 mm3. Ethmoid volume had a moderate positive correlation with proptosis reduction (r s = 0.49, p < .001). Further investigation, statistically significant moderate correlation was found only in the small (SE) and big (BE) ethmoid groups. Conclusion We advise evaluating ethmoid sinus pneumatization on computed tomography before decompression to estimate possible anatomical limitations. Additional wall decompression might be advocated in most severe cases.

Quantification of effective orbital volume and its association with axial length of the eye. A 3D-MRI study

Objective: To measure the effective orbital volume (EOV) from magnetic resonance images, and investigate its relationship with axial length (AL) in those parameters. Methods: Cross-sectional, 3D-MRI study. 54 eyes of 54 patients (25 males) were included in this work. Patient weight, height and head circumference were also measured. Orbital and eyeball volumes were calculated after image segmentation. The difference between those values volume was assessed, estimating the EOV for each eye. Results: Mean eyeball volume was 7.83 ± 2.27 mm3, mean orbital volume 26.81 ± 0.59 mm3 and EOV 21.64 ± 0.19 mm3. The orbital volume was significantly higher in the male group (Wilcoxon signed-rank tests Z=-1.51, p<0.001; Z=-3.57, p<0.001 respectively). EOV was significantly correlated with AL in both males (r=-0.71, p<0.001) and females (r=-0.73, p<0.001), whereas it was also significantly associated with patient height (r=0.261, p=0.03). Associations between EOV and other age, axial and anthropometric characteristics were not statistically significant. Conclusions: Findings of this study could be of valuable importance in various clinical situations in which quantification of orbital volume is needed, such as orbital decompression in Graves' orbitopathy, volume restoration in orbital fractures or other orbital reconstructive surgery. In surgical interventions, clinical relationships should be carefully taken under consideration to avoid iatrogenic injury. Abbreviations: EOV = Effective orbital volume, AL = Axial length, ROI = Region of interest.

Efficacy and complications of orbital fat decompression in Graves’ orbitopathy: a systematic review and meta-analysis

In Graves’ orbitopathy, surgical decompression is often needed for functional and aesthetic reasons. This meta-analysis was performed to assess the efficacy and safety of fat removal orbital decompression (FROD) alone to treat exophthalmos in Graves’ orbitopathy. A systematic search was conducted in PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published before August 2018. Random-effects meta-analyses were applied; weighted means and weighted proportions with corresponding 95% confidence intervals (CI) were calculated. Study quality and quality of evidence for each individual outcome were analyzed. Of 1908 records initially identified, 13 observational studies were selected, representing 4820 orbits in 2514 patients. Weighted Hertel exophthalmometry was 23.10mm (95% CI 21.77–24.43mm) preoperative and 19.31mm (95% CI 17.81–20.81mm) postoperative. The weighted mean difference was 3.81mm (95% CI 3.41–4.21mm). Five studies reported an improvement of diplopia after surgery, occurring in 943 of 1172 patients (weighted proportion 0.50, 95% CI 0.15–0.85). Persistent new onset diplopia was reported in five studies, or 124 of 1277 patients (weighted proportion 0.15, 95% CI 0.03–0.27). No serious adverse events were reported. Results support the effectiveness and safety of FROD to treat mild-to-moderate exophthalmos in Graves’ orbitopathy. Prospective and controlled trials are needed to improve the level of evidence.

Outcome of orbital decompression in graves’ disease using surgical navigation

Outcome of orbital decompression in graves’ disease using surgical navigation

Цветное допплеровское сканирование как метод оценки эффективности декомпрессии орбиты у пациентов с эндокринной офтальмопатией

Цветное допплеровское сканирование как метод оценки эффективности декомпрессии орбиты у пациентов с эндокринной офтальмопатией

Tendon Elongation with Bovine Pericardium in Patients with Severe Esotropia after Decompression in Graves’ Orbitopathy—efficacy and Long-term Stability

ABSTRACTBackground/Aims: We performed a retrospective analysis to examine clinical results, establish a dose-effect coefficient and analyze the long-term efficacy of tendon elongation with bovine pericardium (Tutopatch®) for surgical correction of severe esotropia, occurring after three-wall orbital decompression for dysthyroid optic neuropathy in patients with Graves’ orbitopathy (GO).Methods: Tendon elongation of the medial rectus muscle (MR) was performed in our institution using an interponate of bovine pericardium in 60 patients (27 underwent unilateral and 33 bilateral surgery). Success-rate (total horizontal deviation of 10 prism-diopters (PD) or less and evidence of binocular single vision with or without prism glasses) and horizontal motility were examined 3 months, 1 and >4 years after surgery. A dose-effect coefficient for deviation reduction (PD) per recession distance (mm) was established.Results: Horizontal deviations between 28–80Δ were corrected. Diplopia in primary-gaze disappeared in 65% of the patients after 3 months and in 83% after one year (including 12 patients who underwent subsequent surgery after 3-month follow-up). Patients with deviations ≤40Δ after unilateral and ≤50Δ after bilateral tendon elongation showed higher primary success-rates after 3 months (78% and 72%). Vertical deviations (≤10Δ) were corrected by the procedure in 28% without need of recession of the inferior rectus (IR). Only 3 patients showed overcorrection after one year. One of these underwent revision surgery, in which the interponate was no longer discernible from surrounding fibrotic scar tissue. At >4-year follow-up (4.3–15years) effects were stable and 95% of patients showed fusion in primary gaze. Median dose-effect coefficient was lower after tendon elongation (1.8Δ/mm) compared to conventional medial rectus recession in patients with GO. Horizontal motility was slightly decreased, but much more symmetric around primary gaze.Conclusion: Tendon elongation with a bovine pericardium implant is a safe surgical method, suitable to correct severe esotropia after decompression surgery. A lower dose-effect has to be taken into account. Patients with esotropia ≥42Δ should not be treated with unilateral, but bilateral tendon elongation, to avoid undercorrections. In patients with deviations ≥52Δ it has to be further investigated if the application of even higher elongation distances is viable or if another approach—the recession of more than one rectus muscle has to be performed simultaneously to handle the severe restriction. Generally, a step-by-step approach is advisable, since small vertical deviations could also be corrected in a third of patients with the procedure and the dose-effect was more variable as in medial recessions without tendon elongation.

Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves’ orbitopathy

Background: To determine the clinical outcomes and morbidity of endoscopic medial wall combined with transcutaneous lateral orbital wall decompression in Graves’ orbitopathy.Methodology: A retrospective noncomparative case series of patients who underwent surgical decompression for Graves’ orbitopathy at Hospital Universitario de Fuenlabrada between 2004 and 2014 was performed. We reviewed the patients’ charts and analyzed before and after the decompression, the visual acuity (Snellen chart), optic nerve compression (fundoscopy and optic coherence tomography), exophthalmometry (Hertel measurement), ocular motility, diplopia, eyelid surgery needed after decompression and its possible complications.Results: A total of 20 patients (36 orbits) were operated. The mean follow-up was 44 months (range 18–84). Vision improved dramatically in all compressive optic neuropathy cases (5 cases). Hertel measurements improved on average 3.5 mm (range 1.5–4.5). Diplopia was cured in eight patients (40%) and nine patients with severe preoperative diplopia required strabismus surgery after decompression. Eyelid surgery was further needed in 13 patients. Hyaluronic acid injection was the most used technique for the treatment of eyelid retraction (6 out of 13 patients). Only two major complications were observed: one case had a major post-operative epistaxis and another a cerebrospinal fluid leak. Both were resolved without further sequelae.Conclusions: These results suggest that endoscopic medial wall combined with transcutaneous lateral wall orbital decompression is an effective and safe treatment for the symptomatic dysthyroid eye disease with important proptosis or compressive optic neuropathy.

Long-term outcomes of orbital fat decompression in Graves’ orbitopathy

PurposeTo evaluate the long-term clinical efficacy of orbital fat decompression in treating proptosis in Graves' ophthalmopathy (GO).MethodsRetrospective review of 1604 eyes of 845 patients with symmetric (1518 eyes) and asymmetric...

Changes in pupillary distance after fat versus bony orbital decompression in Graves’ orbitopathy

ObjectiveTo report changes in pupillary distance (PD) after orbital decompression in patients with Graves’ orbitopathy (GO). DesignRetrospective comparative case series. ParticipantsA total of 59 cases who underwent the same type of orbital decompression on both eyes. MethodsThe medical records of 111 patients who underwent orbital decompression were reviewed retrospectively. Fifty-nine patients without restrictive myopathy who underwent the same procedure on both eyes were included. Patients were divided into the following 3 groups by procedure: only fat decompression (group 1, n = 18), fat and medial wall decompression (group 2, n = 11), and fat, medial, and inferior wall decompression (group 3, n = 30). Preoperative and postoperative PD and proptosis were measured. ResultsPD shortened by 2.9 mm in group 1 (p < 0.001), 2.4 mm in group 2 (p < 0.001), and 3.5 mm in group 3 (p < 0.001). Proptosis improved by 3.5 mm in group 1 (p < 0.001), 3.5 mm in group 2 (p < 0.001), and 4.6 mm in group 3 (p < 0.001). PD changes were not significantly different between the groups (p = 0.328). The change in PD was significantly correlated with the mean amount of proptosis reduction (r = 0.374, p = 0.003). ConclusionsPD shortened after orbital decompression in patients with fat proliferative GO. The change in PD was not related to the type of orbital decompression, but rather to the amount of proptosis reduction. Postoperative changes in PD should be considered when performing orbital decompression.

Trends in Orbital Decompression Techniques of Surveyed American Society of Ophthalmic Plastic and Reconstructive Surgery Members.

To assess current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) regarding preference in surgical techniques for orbital decompression in Graves' disease. A 10-question web-based, anonymous survey was distributed to oculoplastic surgeons utilizing the ASOPRS listserv. The questions addressed the number of years of experience performing orbital decompression surgery, preferred surgical techniques, and whether orbital decompression was performed in collaboration with an ENT surgeon. Ninety ASOPRS members participated in the study. Most that completed the survey have performed orbital decompression surgery for >15 years. The majority of responders preferred a combined approach of floor and medial wall decompression or balanced lateral and medial wall decompression; only a minority selected a technique limited to 1 wall. Those surgeons who perform fat decompression were more likely to operate in collaboration with ENT. Most surgeons rarely remove the orbital strut, citing risk of worsening diplopia or orbital dystopia except in cases of optic nerve compression or severe proptosis. The most common reason given for performing orbital decompression was exposure keratopathy. The majority of surgeons perform the surgery without ENT involvement, and number of years of experience did not correlate significantly with collaboration with ENT. The majority of surveyed ASOPRS surgeons prefer a combined wall approach over single wall approach to initial orbital decompression. Despite the technological advances made in the field of modern endoscopic surgery, no single approach has been adopted by the ASOPRS community as the gold standard.

Surgical complications in orbital decompression for Graves' orbitopathy.

SUMMARYThe objective of this study is to analyse the complications of orbital decompression in Graves' orbitopathy. The clinical records of 946 patients who had been operated on with orbital decompression for Graves' orbitopathy were reviewed and the intra- and post-operative complications with minimum follow-up of six months were analysed. An extensive review of the literature was carried out to compare results. In the case-series reported here the most frequent complications were: wasting of the temporal region (100%) in patients operated on using a coronal approach; permanent hypoesthesia of V2 (13%) and V1 (8%) in patients operated on with an upper eyelid incision. In only one patient was a total monolateral lesion of V2 reported. The most severe complications consisted in reduction of visual acuity in 5 patients, and CSF leak with cerebral complications in 2 patients, who were operated on with a non-endoscopic endonasal approach. Three patients had intra-operative haemorrhages and 3 patients had post-operative haemorrhages requiring further surgical intervention. The incidence of symptomatic sinusitis/mucoceles was 0.75%. In conclusion, orbital decompression carried out with endoscopic endonasal technique and via transpalpebral accesses appears to be associated with a low incidence of complications. Knowledge of the causes of the possible complications in the different surgical approaches can definitely help to reduce their incidence.

A novel method for measuring outcome of orbital decompression in Graves’ orbitopathy

SummaryTo evaluate the outcome of a graded bone removal rehabilitative infero‐medial orbital decompression in Graves’ orbitopathy (GO) by means of a novel stratified appraisal (NSA) versus the traditional group analysis (TGA). This retrospective follow‐up study included all the orbits decompressed (06/1999–12/2005), at the Department of Ophthalmology University of Amsterdam by one surgeon (L.B.), using the technique under evaluation. NSA assessed or quantified: (i) the invasiveness of surgery, allowing to calculate a mean index of invasiveness per orbit (MIIO) and per patient (MIIP) (25% ≤ values ≤ 100%); (ii) at ≥ 6 months postoperatively surgical targets (desired exophthalmos reduction, improvement of retroocular tension, reduction of peri‐orbital puffiness, resolution of lagophthalmos) were scored as achieved or not allowing to calculate a mean index of targets achieved per orbit (MITAO) and per patient (MITAP) (0 ≤ values ≤ 1); (iii) an index of diplopia (ID) (decompression‐induced / decompressio‐cured diplopia); (iv) demographics and preoperative characteristics were compared after stratification of the included orbits for surgical target; surgical outcomes were assessed after stratification for amount of desired exophthalmos reduction and invasiveness of surgery. TGA examined the entire series as a single homogeneous cohort independently of the different targets and invasiveness of surgery. NSA and TGA were compared and complications noted. 151 orbits of 84 patients (78% female, mean age 45.5 ± 9.7 years) were included. The NSA detected differences among groups within the studied cohort, the overall achievement of surgical targets was high, indices precisely quantified the extent of applied surgery and surgical results, at variance with results obtained with TGA. A negligible complication rate was recorded. The NSA may represent a step forward towards a more comprehensive and accurate evaluation of decompression surgery outcomes.

Electromagnetic Image-Guided Orbital Decompression: Technique, Principles, and Preliminary Experience with 6 Consecutive Cases

Purpose: To assess the feasibility of routine use of electromagnetic image guidance systems in orbital decompression.Methods: Six consecutive patients underwent stereotactic-guided three wall orbital decompression using the novel Fusion ENT Navigation System (Medtronic), a portable and expandable electromagnetic guidance system with multi-instrument tracking capabilities. The system consists of the Medtronic LandmarX System software-enabled computer station, signal generator, field-generating magnet, head-mounted marker coil, and surgical tracking instruments.In preparation for use of the LandmarX/Fusion protocol, all patients underwent preoperative non-contrast CT scan from the superior aspect of the frontal sinuses to the inferior aspect of the maxillary sinuses that includes the nasal tip.Results: The Fusion ENT Navigation System (Medtronic™) was used in 6 patients undergoing maximal 3-wall orbital decompression for Graves’ orbitopthy after a minimum of six months of disease inactivity. Preoperative Hertel exophthalmometry measured more than 27 mm in all patients. The navigation system proved to be no more difficult technically than the traditional orbital decompression approach.Conclusion: Electromagnetic image guidance is a stereotactic surgical navigation system that provides additional intraoperative flexibility in orbital surgery. Electromagnetic image-guidance offers the ability to perform more aggressive orbital decompressions with reduced risk.

Improvement From No Light Perception after Orbital Decompression for Graves' Optic Neuropathy

Improvement From No Light Perception after Orbital Decompression for Graves' Optic Neuropathy