Results Of Orbital Decompression Research Articles

Orbital Decompression for the Treatment of Spontaneous Globe Luxations

ABSTRACTAims: To describe the results of orbital decompression in patients with spontaneous globe luxations and to evaluate predisposing factors for this condition.Methods: The clinical records of patients who underwent orbital decompression for the treatment of spontaneous globe luxations between 2010 and 2013 were reviewed. Data collected were age, gender, predisposing factors, preoperative and postoperative exophthalmometry, duration of follow-up, presence of diplopia before and after surgery and intra- and postoperative complications.Results: Seven patients underwent orbital decompression after spontaneous globe luxation during the study period. Six patients underwent bilateral decompression. Two patients underwent a three-wall decompression, four of them medial and lateral decompression and one patient medial decompression. The predisposing factors for globe luxation were Graves’ orbitopathy, malar hypoplasia, high myopia, floppy eyelid syndrome and orbital fat hypertrophy in the context of obesity. After orbital decompression, none of the patients reported new globe luxations. No intraoperative complications were observed. None of the patients developed de novo diplopia.Discussion: Orbital decompression is an effective method for the prevention of new episodes in patients with spontaneous globe luxations. It has good aesthetic and functional results and addresses the exophthalmos present in most cases.

Optic neuropathy of graves disease: results of transantral orbital decompression and long-term follow-up in 215 patients

Purpose To review demographic characteristics, clinical features, and long-term outcomes of patients with optic neuropathy of Graves disease after transantral orbital decompression. Design Retrospective analysis of noncomparative interventional case series; long-term follow-up by questionnaire. Methods Medical record data (preoperative and postoperative assessments) were collected from patients who had transantral orbital decompression to treat Graves optic neuropathy. Responses to two follow-up questionnaires concerning patient satisfaction were evaluated. Statistical analysis (reflected as P values) compared preoperative and early postoperative (≤182 days) data. Results Between November 1969 and May 1989, 215 patients underwent transantral orbital decompression for Graves optic neuropathy. In 205 eyes with visual acuity of 20/40 or worse before decompression, visual acuity improved by 3 Snellen lines or more in 110 (54%) ( P < .001). Of 291 eyes with visual field defects preoperatively, 120 (41%) had resolution, and 126 (43%) had improvement postoperatively ( P < .001). Proptosis was reduced in 350 eyes by 4.4 ± 2.3 mm (mean ± SD) ( P < .001). In 104 eyes, disk edema resolved in 72 (69%) and improved in 28 (27%). Responses to questionnaires mailed in 1990 and 2000 showed that 76% and 88% of respondents, respectively, were subjectively satisfied with the results of orbital decompression. Conclusions Transantral orbital decompression appeared to be effective in treating optic neuropathy of Graves disease. Patient satisfaction was high at 10-year and 20-year follow-up.

Results of orbital decompression in Taiwan

Orbital decompression was performed on 116 orbits with Graves' ophthalmopathy. The indications for decompression were dysthyroid optic neuropathy (DON), recalcitrant corneal exposure (EXP) and disfiguring exophthalmos (COS). All cases but one (in the DON group) had improved or unchanged vision. The average retinal sensitivity improvement in the DON group was 6.7 ± 6.1 dB and 85% had a significant retinal sensitivity improvement (>5 dB). The average retroplacement effect was 4.4 ± 2.1 mm and only five cases (7%) had postoperative asymmetry of more than 2 mm by Hertel's exophthalmometry. The most frequent sequela was diplopia, which tended to occur in more severely myopathic eyes. In our series, 21% (10/48 cases without preoperative diplopia) developed diplopia after decompressive surgery. Hypoglobus is another complication, noted in two cases, which was successfully repositioned. In conclusion, decompressive surgery is a safe and effective procedure to restore vision and reduce exophthalmos in Graves' ophthalmopathy. Careful evaluation of clinical parameters, individualization of surgical goals and intraoperative titration of the retroplacement effect are the key to optimal results.

Surgical Treatment of Thyrotoxic Exophthalmos

Conservative treatment of thyrotoxic exophthalmos has not given satisfactory results. Our observations, modifications of the standard surgical technique, and the results of orbital decompression for this condition are presented. Through a transverse incision close to the lower eyelid margin, the floor and the lateral orbital wall are explored. The posterior part of the orbital floor and the zygomatic part of the lateral orbital wall, as well as the periorbital fat, are removed. Through an incision made over the medial margin of the orbit, the medial orbital wall is explored and its ethmoidal part is removed. By the same approach, further retrobulbar fat is removed. Through an upper eyelid incision, fat is removed from the eyelid region and the levator aponeurosis is divided. This produces satisfactory symmetrical decompression of the orbit with good correction of exophthalmos and a significant decrease in the signs and symptoms of this condition.