Orbital Decompression In Patients Research Articles

Superficial ocular vascular changes after orbital decompression in patients with thyroid ophthalmopathy measured by anterior segment OCT angiography; an observational study

Thyroid eye disease (TED) is a common ophthalmologic manifestation of thyroid dysfunction. Despite various imaging techniques available, there hasn't been a widely adopted method for assessing the anterior segment vasculature in TED patients. Our study aimed to evaluate alterations in ocular surface circulation following orbital decompression surgery in TED patients and investigate factors influencing these changes. Using anterior segment optical coherence tomography-angiography (AS-OCTA), we measured ocular surface vascularity features, including vessel density (VD), vessel diameter index (VDI), and vessel length density (VLD), both before and after decompression surgery, alongside standard ophthalmic examinations. Our AS-OCTA analysis revealed a significant decrease in most of the temporal vasculature measurements six weeks post-surgery (p < 0.05). However, differences in the nasal region were not statistically significant. These findings indicate notable changes in ocular surface circulation following orbital decompression in TED patients, which may have implications for intraocular pressure (IOP) control and ocular surface symptoms management. AS-OCTA holds promise as a tool for evaluating the effectiveness of decompression surgery and assessing the need for further interventions.

Association of the Preoperative Fat-to-ratio on the Outcome of Endoscopic Orbital Decompression

Purpose: To investigate the association of the preoperative fat-to-orbit ratio on the outcome of endoscopic orbital decompression in patients with thyroid-associated orbitopathy (TAO).Methods: Between January 2021 and December 2022, 36 patients with TAO, 72 eyes in total, underwent endoscopic orbital decompression at our hospital’s ophthalmology department. We calculated fat-to-orbit ratios using two-dimensional facial computed tomography scans, and conducted both preoperative and postoperative measurements of proptosis and the prism cover test. We used binominal logistic regression analysis to examine the correlation between the ratios and postoperative complications (diplopia, strabismus, lid retraction) following the surgery. Furthermore, simple linear regression analysis was used to assess the relationship between the ratios and change in exophthalmos.Results: The regression indicated significant associations between the ratio and the onset of postoperative complications such as new-onset postoperative diplopia (NOPD) (β = -0.098, &lt;i&gt;p&lt;/i&gt; = 0.029), postoperative strabismus (β = -0.123, &lt;i&gt;p&lt;/i&gt; = 0.009), and eyelid retraction (β = -0.188, &lt;i&gt;p&lt;/i&gt; = 0.002), particularly in cases requiring subsequent strabismus or eyelid retraction surgery after the initial procedure.Conclusions: The preoperative fat-to-orbit ratio is a significant predictor of postoperative complications such as NOPD, strabismus surgery and eyelid retraction surgery in patients undergoing endoscopic orbital decompression for thyroid eye disease. Therefore, it should be considered a valuable indicator of surgical outcomes and complications in such patients.

Quality of life in patients with Graves' orbitopathy submitted to orbital decompression: comparison between balanced and inferomedial techniques.

To compare inferomedial wall orbital decompression to balanced medial plus lateral wall orbital decompression in patients with Graves' orbitopathy in the inactive phase with regard to exophthalmos reduction and the effects on quality of life. Forty-two patients with inactive Graves' orbitopathy were randomly divided into two groups and submitted to one of two orbital decompression techniques: inferomedial wall orbital decompression or medial plus lateral wall orbital decompression. Preoperative and postoperative assessments included Hertel's exophthalmometry and a validated Graves' orbitopathy quality of life questionnaire. The results of the two groups were compared. Compared to preoperative measurement, exophthalmos reduction was statistically significant in both groups (p<0.001) but more so in patients undergoing medial plus lateral wall orbital decompression (p=0.010). Neither orbital decompression techniques increased the visual functioning subscale score on the Graves' orbitopathy quality of life questionnaire (inferomedial wall orbital decompression p=0.362 and medial plus lateral wall orbital decompression p=0.727), but a statistically significant difference was observed in the score of the appearance subscale in patients submitted to medial plus lateral wall orbital decompression (p=0.006). Inferomedial wall orbital decompression is a good alternative for patients who do not require large exophthalmos reduction. However, medial plus lateral wall orbital decompression offers greater exophthalmos reduction and greater improvement in appearance (higher Graves' orbitopathy quality of life questionnaire scores), making it a suitable option for esthetic-functional rehabilitation.

Bony orbital decompression in thyroid eye disease

This article summarizes the results of research on the morphological and functional features of different types of orbital bone decompression in thyroid eye disease (TED) and presents an analysis of surgical anatomy of the lateral orbital wall in the context of performing deep lateral bone decompression of the orbit was carried out. The study includes an analysis of the results of orbital bone decompression with resection of the greater wing of the sphenoid bone using ultrasound osteodestructor in comparison with osteodestruction using a high-speed drill, description of transethmoidal orbital decompression with endonasal access both as a single method of surgical treatment of TED and in combination with lateral bone decompression of the orbit, including the advantages and disadvantages of the method, and presents a morphological description of the pathological changes in the medial orbital wall bone fragments obtained during endonasal transethmoidal orbital decompression in patients with TED.

Comparison of surgical effect in active and inactive Dysthyroid Optic Neuropathy after Endoscopic Transnasal Medial Orbital Decompression.

To evaluate and compare the changes in orbital soft tissue volume and visual function after endoscopic transnasal medial orbital decompression in patients with active and inactive dysthyroid optic neuropathy (DON). This prospective, cohort study recruited 112 patients (112 eyes) with DON who were divided into an active and inactive DON group (56 eyes each) by clinical activity scores. All patients underwent endoscopic transnasal medial orbital decompression. The pre- and post-operative orbital soft tissue volumes were measured with high-resolution computed tomography (CT) using Mimics software. Visual function, including best-corrected visual acuity (BCVA), visual field (VF), and visual evoked potential (VEP), was recorded before and after surgery. Preoperatively, compared with the inactive DON group, the active DON group had greater extraocular muscle volume (EMV) and EMV/orbital volume (OV) ratio, but worse BCVA, VF, and exophthalmos. Postoperatively, although the EMV slightly increased, with the enlarged medial rectus muscle contributing dramatically, the EMV/OV ratio decreased in patients with DON. Besides, visual function including BCVA, VF, VEP and exophthalmos was also improved in both groups after surgery. There were no significant differences in postoperative OV; EMV; EMV/OV ratio; and the BCVA, VF, and VEP parameters between both groups (all P > 0.05). Patients with DON who did not respond well to steroids, regardless of disease activity, may benefit from orbital decompression via the decrease in the proportion of EMV in OV, especially patients with active DON, who showed more improved visual function than patients with inactive DON.

Letter to the Editor “Challenges of Meeting Cerebrovascular Surgery Demands in Low-and Middle-Income Countries: An Experience from Iraq”

The endoscopic endonasal approach (EEA) was originally performed to treat thyroid orbitopathy and proptosis. Since then, this approach also has been used to treat other causes of proptosis. This review systematically identifies surgical outcome and complication rates in patients without thyroid proptosis who underwent endoscopic endonasal orbital decompression.Databases were searched using the following search terms: orbital disease, surgical decompression, and endoscopic endonasal approach. Two independent reviewers screened all abstracts and titles for relevance and all articles passing this screen were subjected to full-text review. To assess risk of bias, we used ROBINS-I (Risk Of Bias in Non-randomized Studies–of Interventions).Eight studies with a total of 74 patients with nonthyroid proptosis were included. Pre- and postoperative eye examination was performed in all studies, but the extent of examination was varying. With a mean age of 35.7 years, most patients were adolescent, and most pathologies induced unilateral proptosis Complications to EEA for orbital decompression were transient diplopia (5 patients/6.8%), transient facial dysesthesia (2 patients/2.7%), ptosis (1 patient/1.4%), infarction (1 patient/1.4%), sinus obstruction (1 patient/1.4%), and enophtalmos (1 patient/1.4%). The authors reported successful reduction of proptosis in all but 2 patients (97.2%), and only 2 authors reported a need for secondary decompression.Medial orbital decompression using EEA is a feasible approach for orbital decompression in patients with nonthyroid proptosis. While being comparable in primary outcome to transorbital approaches, the EEA seems superior in terms of complication rates

Proposing a surgical algorithm for graduated orbital decompression in patients with Graves\u2019 orbitopathy

PurposeTo determine the outcome after orbital decompression using a graduated technique, adapting the surgical technique according to individual patients’ disease characteristics.MethodsWe retrospectively examined the postoperative outcome in patients treated with a graduated balanced orbital decompression regarding reduction of proptosis, new onset diplopia and improvement in visual function. 542 patients (1018 orbits) were treated between 2012 and 2020 and included in the study. Clinical examinations including visual acuity, exophthalmometry (Hertel) and orthoptic evaluation were performed preoperatively and at minimum 6 weeks postoperatively. Mean follow-up was 22.9 weeks.ResultsMean proptosis values have significantly decreased after surgery (p < 0.01). In 83.3% of the patients Hertel measurement normalized (≤ 18 mm) after surgery, New onset diplopia within 20° of primary position occurred in 33.0% of patients, of whom 16.0% had preoperative double vision in secondary gaze. Patients suffering from dysthyroid optic neuropathy (DON) had a significant increase in visual acuity (p < 0.01).ConclusionWe demonstrated that individually adapted graduated orbital decompression successfully improves key disease parameters of Graves’ orbitopathy with low morbidity.

Factors Associated with Postoperative Strabismus by Endoscopic Orbital Decompression in Patients with Thyroid-associated Ophthalmopathy

Factors Associated with Postoperative Strabismus by Endoscopic Orbital Decompression in Patients with Thyroid-associated Ophthalmopathy

Endoscopic Orbital Decompression for Graves' Orbitopathy - A Vietnam Study.

PurposeTo evaluate the efficacy and safety of endoscopic orbital decompression in patients with Graves’ orbitopathy.Patients and MethodsThis is a prospective study in Hanoi Medical University and a Military Hospital from December 2017 to December 2018. Twenty-eight orbits of fifteen patients were undergoing endoscopic orbital decompression for Graves’ orbitopathy. Indications for surgery were proptosis in twenty-two orbits and compressive optic neuropathy in six orbits. The outcome measures were proptosis reduction, visual acuity, visual field test and diplopia. Post-operative complications including cerebrospinal fluid leakage, haemorrhage, lacrimal duct impairment, worsening diplopia, sinusitis and cellulitis were collected.ResultsThe mean proptosis reduction was 2.23 mm. Visual acuity and medium deviation in the Humphrey visual field were significantly improved in four of six eyes with compressive optic neuropathy. There was one patient with intra-operative excessive bleeding which resolved without affecting visual outcome. Post-operatively, two patients developed a new onset of diplopia and two others worsened diplopia; three have already undergone successful strabismus surgery and moderate proptosis reduction.ConclusionEndoscopic orbital decompression surgery was effectively and safely to manage compressive optic neuropathy of Graves’ orbitopathy and moderately reduce proptosis in a group of Vietnamese patients.

Thyroid eye disease treated with orbital decompression surgery versus repeated peribulbar injection of triamcinolone

Background Thyroid eye disease (TED) is the most common autoimmune disease of the orbit. Management includes conservative measures, medical therapy, surgery, and targeted biologic therapy. Aim To compare the efficacy of repeated peribulbar triamcinolone injections with surgical orbital decompression in patients with moderate to severe TED. Patients and methods A prospective nonrandomized, noncontrolled comparative interventional study was conducted that included 30 eyes with moderate to severe inactive TED, which were divided into two groups: group A included 15 eyes that were enrolled for surgical orbital decompression and group B included 15 eyes that underwent repeated peribulbar triamcinolone injections. Patients were subjected to preoperative and postoperative ophthalmological examination, including visual acuity, intraocular pressure measurement, and degree of proptosis. Results Hertel's exophthalmometer measurements showed mean±SD difference between preoperative and postoperative values in group A of 6.20±1.32, whereas group B had 2.53±0.92, revealing high statistically significant differences between preoperative and postoperative results in each group as well as between both groups. Differences in intraocular pressure values between preoperative and postoperative periods in group A were 1.73±1.39 and in group B were 1.13±0.92, showing a highly statistically significant difference. Concerning refraction, the mean difference between preoperative and postoperative periods in sphere, cylinder, and axis in group A showed a highly statistically significant difference in cylinder and axis, whereas only cylinder and not axis in group B. Conclusion Both repeated peribulbar injection of triamcinolone and surgical orbital decompression are effective modalities for management of moderate and severe inactive TED, with surgical orbital decompression having the upper hand in providing better results in reduction of proptosis.

Tear proteomics of orbital decompression for disfiguring exophthalmos in inactive thyroid‑associated ophthalmopathy

The progress and achievements that have been made in tear proteomics in thyroid-associated ophthalmopathy (TAO) are critical for exploring the pathogenesis of TAO and investigating potential therapeutic targets. However, the tear proteomics of orbital decompression for disfiguring exophthalmos in inactive TAO have yet to be properly investigated. In the present study, orbital decompression was performed to repair disfiguring exophthalmos in patients with inactive TAO. Tears were collected before and after orbital decompression in patients with inactive TAO. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) was performed to explore the changes in tear proteomics. Bioinformatics analyses were then employed to analyze the functions of the differentially expressed proteins (DEPs) identified by LC-MS/MS. The palpebral fissure height and exophthalmia area were significantly restored after 1 month of orbital decompression such that they approached the normal levels identified in healthy eyeballs. Among the 669 proteins identified by LC-MS/MS, 83 proteins were changed significantly between the preoperative and postoperative stages in inactive TAO patients and healthy control individuals. The DEPs were predicted to be involved in numerous signaling pathways. Bioinformatics analyses revealed that pathways associated with the immune system, metabolism, programmed cell death, vesicle-mediated transport, neuronal system and extracellular matrix organization may fulfill significant roles in orbital decompression in patients with inactive TAO. Taken together, these results provided a preliminary understanding of the mechanism of orbital decompression for disfiguring exophthalmos in inactive TAO patients.

Bony Orbital Decompression in Patients with High Myopia and Pseudoexophthalmos.

High myopic eyes grow in length (> 0.35 mm/dpt) more than in height and width leading to a disturbing unilateral exophthalmos in patients with anisomyopia and - more rarely - a bilateral exophthalmos in high myopia affecting both eyes. Secondary consequences are sicca symptoms and painful eye mobility due to a large bulbus in a too small bony orbit. The aim of the work was to evaluate the effectiveness of bony orbital compression in cases of high myopia. Four patients underwent bony orbital decompression between the years 2012 and 2019. Two of the patients received lateral and two of them balanced (medial endonasal endoscopic and lateral) decompression. The decompression effect, complications and the influence of decompression on eye position and motility were evaluated. Significant decompression effect was achieved in all patients. As a result, symmetry was restored in all unilaterally affected patients. No complications occurred. The lateral decompression had a positive effect on the preexisting convergent strabismus (reduction of the "eso" position, neutral to the vertical deviation). The carefully dosed medial decompression did not lead to any change of the horizontal position in one patient and in the other exotropic patient it resulted in a 10 pdpt of "exo" reduction without developing an "eso" position. The bony orbital decompression provides a sufficient decompression effect in the four patients to reduce the myopic pseudoexophthalmos. The alignment anomalies associated with a high myopia ("heavy eye") was favourably influenced by the lateral decompression.

Evaluation of medical and surgical decompression in patients with dysthyroid optic neuropathy

PurposeTo evaluate the effectiveness of steroid-pulse therapy and three-wall orbital decompression in patients with dysthyroid optic neuropathy (DON).MethodsTwenty-five patients (46 eyes) with a diagnosis of DON between 2008 and 2015 were included in the study. The first group (7 patients, 16 eyes) consisted of patients with a steroid-pulse treatment only and the second group (18 patients, 30 eyes) included patients with medical and surgical decompression.ResultsTwenty patients were female; five patients were male. After the diagnosis of DON, all patients were treated with steroid-pulse treatment (intravenous 500 mg prednisolon twice/week for 4 weeks, 250 mg twice/week for 2 weeks) as a first-line treatment (medical decompression). In 30 eyes (18 patients) out of 46 eyes, (25 patients) an orbital decompression was needed to preserve the optic nerve function. In those therapy-resistant cases (surgical decompression group), the orbital decompression led to statistically significant improvements in best-corrected visual acuity (BCVA), protan and tritan value of the color vision (p = 0.007, p < 0.0001, p = 0.019, respectively, comparison of first visit to last visit).ConclusionAccording to our data, the mild cases of DON with better initial visual acuity (in our case series mean: 0.3 logMAR) seem to respond well to steroid treatment. However, therapy-resistant cases with an impaired initial BCVA (in our case series, mean: 0.6 logMAR) seem to need the surgery to preserve the optic nerve function. In conclusion, this retrospective study confirms the effectiveness of surgical decompression in therapy-resistant cases of DON.

Efficacy of transethmoidal orbital decompression in patients with dysthyroid optic neuropathy

To estimate efficacy and safety of endoscopic orbital decompression in patients with dysthyroid optic neuropathy (DON). 19 patients aged 54.8±7.1 y.o. with DON were enrolled into the study. Visual acuity was from counting fingers till 0.9 (0.4±0.28) before surgery, it increased till 0.7±0.2 (p<0.05) after surgery. The amount of correct Ishihara plates increased from 5.8±7 till 13.3±7.6 (p<0.05). Exophthalmos reduced by 1.7 mm (p<0.05). Significant reduce of orbital inflammation was noted as well. This study is the first study of this kind in Russian Federation. Obtained results showed high efficacy and safety of endoscopic orbital decompression in patients with DON.

Dysthyroid optic neuropathy: surgical treatment potential

To evaluate the effectiveness of bony orbital decompression in patients with dysthyroid optic neuropathy (DON). The study analyzed 255 patients with thyroid eye disease (TED) and bony orbital decompression. Those among them who had DON as an indication for surgery were investigated further. Patients underwent standard ophthalmological examination, computer perimetry, color vision assessment using Ishihara tables, relative afferent pupillary defect (RAPD), computed tomography (CT) of the orbit, and in some cases optical coherence tomography (OCT) of the optic nerve. Final analysis included 31 patients (52 eyes). On 13 orbits, only lateral wall decompression was performed, and medial wall decompression was the only intervention in 7 orbits. In other cases, these techniques were performed either simultaneously - in 14 orbits, or alternately - in 18 orbits. In the postoperative period, all patients showed significant positive dynamics in terms of visual acuity, visual field, and proptosis. In all cases, decrease of the amount of orbital inflammation was observed. Exophthalmos significantly decreased after surgery and averaged 20.5±3.1 mm, which is 4.7 mm less than the initial one. All changes were statistically significant (p<0.01). Bony orbital decompression is an effective and safe treatment option for DON resistant to high doses of glucocorticoids. In the vast majority of cases, this intervention is the only way to improve and stabilize visual function in this severe category of patients.

Endoscopic orbital fat decompression for the management of proptosis in Grave's orbitopathy using a laryngeal skimmer blade.

Intraoperative handling and manipulation of orbital fat remains a challenge to orbital surgeons. We present a case series of endoscopic orbital fat decompression with medial orbital wall decompression for proptosis management in Grave's orbitopathy, describing a technique for fat excision using a laryngeal skimmer blade, reporting clinical and surgical outcomes, and complications. All patients who underwent endoscopic orbital fat decompression, with medial orbital wall decompression, for proptosis management in Grave's orbitopathy between 2011 and 2018, under the care of a single surgeon, were included in this retrospective interventional case series. Nineteen patients were included in this study. Using a laryngeal skimmer blade, orbital fat was excised endoscopically at the time of medial orbital wall decompression. The mean volume of orbital fat excised was 1.45 ± 0.63 ml and the mean reduction in proptosis was 4.5 ± 1.02 mm. There were no intraoperative complications. In this study, we describe our experience of using a laryngeal skimmer blade as a method of excising orbital fat for orbital decompression in patients with proptosis secondary to Grave's orbitopathy.

О возможности использования новой модели остеодеструктора при декомпрессии орбиты у пациентов с эндокринной офтальмопатией (ЭОП)

О возможности использования новой модели остеодеструктора при декомпрессии орбиты у пациентов с эндокринной офтальмопатией (ЭОП)

The Clinical Result of Medial Orbital Decompression in Patients with Thyroid-associated Orbitopathy

The Clinical Result of Medial Orbital Decompression in Patients with Thyroid-associated Orbitopathy

Comparative electron microscopy study of the bone surfaces relief after ultrasonic and mechanical high-speed bone removal in orbital decompression

To compare the results of scanning electron microscopy studies of the surface of bone fragments of orbital lateral wall formed by mechanical and ultrasonic bone removal devices. The surfaces of 7 bone fragments have been investigated after bony orbital decompression in patients with thyroid eye disease (TED). Electron microscopy of the bone relief was performed after exposure to an ultrasonic surgical system or a high-speed drill. Electron microscopy revealed that relief of the bony surface within a compact substance after application of an ultrasonic aspirator had parallel grooves of the same type up to 100 μm in depth and 80-100 μm wide, with relatively smooth edges. In the area of impact on spongy substance the bone surface became more amorphous, rougher due to the exposure of cellular structures at different depths. High-speed drill used in the area of compact substance left monotonous, almost flat relief with individual compact conglomerates of bone 'dust'. Removal of thinned fragments of the compact substance of the specimen led to appearance of the cellular structure typical for a spongy substance. Data on features of the relief of the edges of bone 'window' obtained for the first time, as well as specifics of working in conditions of limited surgical access allowed the conclusion that modern ultrasonic bone aspiration is promising for deep lateral wall decompression and some other orbital interventions.

The influence of orbital decompression on objective nasal function in patients with graves' orbitopathy.

To determine the influence of anatomical changes after orbital decompression to nasal function. We examined postoperative nasal function after orbital decompression in patients with GO in a prospective study. 25 patients were enrolled between 2014 and 2016. Sense of smell (Sniffin' Test) and nasal airflow (anterior rhinomanometry) were tested pre- and 6weeks postoperatively. In addition, postoperative incidence of sinus infections, persistent pressure pain, and infraorbital hypoesthesia were assessed by means of a questionnaire. The olfactory performance showed a significant increase (p < 0.05) after surgery, while the nasal airflow significantly decreased (p < 0.05). Acute sinus infection occurred in three, infraorbital sensibility disorders in eight cases within the first 6weeks after surgery. No persistent pain was recorded. We demonstrate that decompression of the medial orbital wall leads to a decrease in nasal airflow, whereof patients should be informed before the procedure. This is most likely due to a medialization of the medial turbinate and the prolapse of orbital content into the nasal cavity. The increase of the olfactory performance is, in our opinion, more likely due to variation within the standard deviation than to anatomical changes.