Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroidassociated Ophthalmopathy
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Purpose: To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelidsurgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO). Methods: Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement ordiplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customizedorbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneouslyperformed. The patients had a minimum preoperative period of 3 months of stable range of ocularmotility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperativeand postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry,ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performedin all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0). Results: Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 ±11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 ± 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertelmeasurement of 17.6 ± 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle inthree cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increasedin all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgicalsession in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgicalsession in two cases. Margin reflex distance decreased from a preoperative average of 4.3 ± 0.8 to 3.8 ± 0.5mm postoperatively. Conclusions: The customized orbital decompression procedure decreased proptosis and improved diplopia,in a range comparable to those achieved through more stepwise techniques, and had favorablecosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.
Abstract
Purpose: To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelidsurgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO). Methods: Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement ordiplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customizedorbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneouslyperformed. The patients had a minimum preoperative period of 3 months of stable range of ocularmotility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperativeand postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry,ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performedin all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0). Results: Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 ±11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 ± 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertelmeasurement of 17.6 ± 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle inthree cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increasedin all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgicalsession in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgicalsession in two cases. Margin reflex distance decreased from a preoperative average of 4.3 ± 0.8 to 3.8 ± 0.5mm postoperatively. Conclusions: The customized orbital decompression procedure decreased proptosis and improved diplopia,in a range comparable to those achieved through more stepwise techniques, and had favorablecosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.
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