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Graded decompression of orbital fat and wall in patients with Graves' orbitopathy.
Korean J Ophthalmol 2014; 28(1):1-11KJ

Abstract

PURPOSE

To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings.

METHODS

This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved.

RESULTS

FOUR TYPES OF DECOMPRESSION WERE PERFORMED: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 ± 2.8 mm) was reduced significantly at six months postoperatively (16.1 ± 2.3 mm). Proptosis significantly decreased with a mean of 4.3 ± 1.7 mm, and the reduction was greatest (5.1 ± 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy.

CONCLUSIONS

Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis.

Authors+Show Affiliations

Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.Department of Ophthalmology, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24505195

Citation

Lee, Kyou Ho, et al. "Graded Decompression of Orbital Fat and Wall in Patients With Graves' Orbitopathy." Korean Journal of Ophthalmology : KJO, vol. 28, no. 1, 2014, pp. 1-11.
Lee KH, Jang SY, Lee SY, et al. Graded decompression of orbital fat and wall in patients with Graves' orbitopathy. Korean J Ophthalmol. 2014;28(1):1-11.
Lee, K. H., Jang, S. Y., Lee, S. Y., & Yoon, J. S. (2014). Graded decompression of orbital fat and wall in patients with Graves' orbitopathy. Korean Journal of Ophthalmology : KJO, 28(1), pp. 1-11. doi:10.3341/kjo.2014.28.1.1.
Lee KH, et al. Graded Decompression of Orbital Fat and Wall in Patients With Graves' Orbitopathy. Korean J Ophthalmol. 2014;28(1):1-11. PubMed PMID: 24505195.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Graded decompression of orbital fat and wall in patients with Graves' orbitopathy. AU - Lee,Kyou Ho, AU - Jang,Sun Young, AU - Lee,Sang Yeul, AU - Yoon,Jin Sook, Y1 - 2014/01/21/ PY - 2013/02/06/received PY - 2013/05/02/accepted PY - 2014/2/8/entrez PY - 2014/2/8/pubmed PY - 2015/4/14/medline KW - Decompression KW - Exophthalmos KW - Graves ophthalmopathy KW - Orbit SP - 1 EP - 11 JF - Korean journal of ophthalmology : KJO JO - Korean J Ophthalmol VL - 28 IS - 1 N2 - PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. RESULTS: FOUR TYPES OF DECOMPRESSION WERE PERFORMED: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 ± 2.8 mm) was reduced significantly at six months postoperatively (16.1 ± 2.3 mm). Proptosis significantly decreased with a mean of 4.3 ± 1.7 mm, and the reduction was greatest (5.1 ± 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. CONCLUSIONS: Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis. SN - 2092-9382 UR - https://www.unboundmedicine.com/medline/citation/24505195/Graded_decompression_of_orbital_fat_and_wall_in_patients_with_Graves'_orbitopathy_ L2 - https://ekjo.org/DOIx.php?id=10.3341/kjo.2014.28.1.1 DB - PRIME DP - Unbound Medicine ER -