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Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves' orbitopathy.
Acta Otolaryngol 2017; 137(11):1183-1187AO

Abstract

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.

Authors+Show Affiliations

a Department of Otolaryngology , Hospital Universitario de Fuenlabrada Madrid , Spain.b Department of Ophthalmology , Hospital Universitario de Fuenlabrada , Madrid , Spain.a Department of Otolaryngology , Hospital Universitario de Fuenlabrada Madrid , Spain.b Department of Ophthalmology , Hospital Universitario de Fuenlabrada , Madrid , Spain.b Department of Ophthalmology , Hospital Universitario de Fuenlabrada , Madrid , Spain.b Department of Ophthalmology , Hospital Universitario de Fuenlabrada , Madrid , Spain.b Department of Ophthalmology , Hospital Universitario de Fuenlabrada , Madrid , Spain.a Department of Otolaryngology , Hospital Universitario de Fuenlabrada Madrid , Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28741406

Citation

Hernández-García, Estefanía, et al. "Balanced (endoscopic Medial and Transcutaneous Lateral) Orbital Decompression in Graves' Orbitopathy." Acta Oto-laryngologica, vol. 137, no. 11, 2017, pp. 1183-1187.
Hernández-García E, San-Román JJ, González R, et al. Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves' orbitopathy. Acta Otolaryngol. 2017;137(11):1183-1187.
Hernández-García, E., San-Román, J. J., González, R., Nogueira, A., Genol, I., Stoica, B., ... Plaza, G. (2017). Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves' orbitopathy. Acta Oto-laryngologica, 137(11), pp. 1183-1187. doi:10.1080/00016489.2017.1354394.
Hernández-García E, et al. Balanced (endoscopic Medial and Transcutaneous Lateral) Orbital Decompression in Graves' Orbitopathy. Acta Otolaryngol. 2017;137(11):1183-1187. PubMed PMID: 28741406.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves' orbitopathy. AU - Hernández-García,Estefanía, AU - San-Román,J Javier, AU - González,Ramón, AU - Nogueira,Araceli, AU - Genol,Ignacio, AU - Stoica,Bazil, AU - Toledano,Nicolás, AU - Plaza,Guillermo, Y1 - 2017/07/25/ PY - 2017/7/26/pubmed PY - 2018/5/31/medline PY - 2017/7/26/entrez KW - Thyroid eye disease KW - compressive optic neuropathy KW - decompression KW - diplopia KW - orbit KW - proptosis SP - 1183 EP - 1187 JF - Acta oto-laryngologica JO - Acta Otolaryngol. VL - 137 IS - 11 N2 - 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. SN - 1651-2251 UR - https://www.unboundmedicine.com/medline/citation/28741406/Balanced__endoscopic_medial_and_transcutaneous_lateral__orbital_decompression_in_Graves'_orbitopathy_ L2 - http://www.tandfonline.com/doi/full/10.1080/00016489.2017.1354394 DB - PRIME DP - Unbound Medicine ER -