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Influence of orbital morphology on proptosis reduction and ocular motility after decompression surgery in patients with Graves' orbitopathy.

Abstract

PURPOSE

Orbital decompression surgery is performed in patients with Graves' orbitopathy to treat dysthyroid optical neuropathy (DON) and reduce disfiguring proptosis. The intended proptosis reduction can deviate from the postoperative result and changes of motility with consecutive diplopia can occur. We performed a retrospective study to identify anatomical factors in computed tomography (CT), which influence the surgical effect and postoperative ocular motility and diplopia.

METHODS

Pre- and postoperative CT-scans of 125 eyes of 68 patients, who mainly underwent a balanced orbital decompression for disfiguring proptosis (≥18mm Hertel Index), have been analyzed. Proptosis, ductions, misalignment and diplopia were assessed before and after surgery. Medial and lateral orbital wall length, conus angle, depth of ethmoidal sinus, orbital surface, length of medial and orbital defect, depth of tissue prolapse and horizontal muscle diameters were analyzed in CT scans before and after surgery. With linear regression and multivariate analyses these parameters have been correlated with postoperative proptosis, abduction deficit, deviation and binocular single vision (BSV).

RESULTS

Proptosis could be reduced by 5.3±2mm. Patients with <5mm proptosis reduction had significantly less often new onset of diplopia compared to patients with >5mm reduction (13% vs. 56%, p = 0.02). Multiple linear regression showed a significant correlation between tissue prolapse and depth of the ethmoidal sinus as well as age (p<0.001, r = 0.71). Proptosis reduction could not be predicted by tissue prolapse, defect length or depth of ethmoidal sinus. The abduction deficit correlated significantly with tissue prolapse and orbital surface area (p<0.001, r = 0.37) but not with the horizontal muscle diameter.

CONCLUSION

We were able to show that orbital morphology influences the outcome of balanced orbital decompression surgery in terms of proptosis reduction and motility. However, the rather low coefficients of correlation show that the surgical outcome cannot be predicted with simple CT measurements, although risk factors for postoperative abduction deficit could be found. Therefore, preoperative planning should consider especially the orbital surface area and depth of ethmoidal sinus. Patients should be informed about the higher risk of diplopia with higher proptosis reduction.

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  • Authors+Show Affiliations

    ,

    Department of Ophthalmology, University Hospital Essen, Essen, Germany.

    ,

    Department of Ophthalmology, University Hospital Essen, Essen, Germany. Department of Gynecology, University Hospital Oldenburg, Oldenburg, Germany.

    ,

    Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.

    ,

    Department of Radiology, Maria Hilf Hospital, Mönchengladbach, Germany.

    ,

    Department of Radiology and Neuroradiology, Alfried Krupp Hospital Essen, Essen, Germany.

    ,

    Department of Ophthalmology, University Hospital Essen, Essen, Germany.

    ,

    Department of Ophthalmology, University Hospital Essen, Essen, Germany.

    Department of Gynecology, University Hospital Oldenburg, Oldenburg, Germany.

    Source

    PloS one 14:6 2019 pg e0218701

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31233522

    Citation

    Oeverhaus, Michael, et al. "Influence of Orbital Morphology On Proptosis Reduction and Ocular Motility After Decompression Surgery in Patients With Graves' Orbitopathy." PloS One, vol. 14, no. 6, 2019, pp. e0218701.
    Oeverhaus M, Copei A, Mattheis S, et al. Influence of orbital morphology on proptosis reduction and ocular motility after decompression surgery in patients with Graves' orbitopathy. PLoS ONE. 2019;14(6):e0218701.
    Oeverhaus, M., Copei, A., Mattheis, S., Ringelstein, A., Tiemessen, M., Esser, J., ... Stähr, K. (2019). Influence of orbital morphology on proptosis reduction and ocular motility after decompression surgery in patients with Graves' orbitopathy. PloS One, 14(6), pp. e0218701. doi:10.1371/journal.pone.0218701.
    Oeverhaus M, et al. Influence of Orbital Morphology On Proptosis Reduction and Ocular Motility After Decompression Surgery in Patients With Graves' Orbitopathy. PLoS ONE. 2019;14(6):e0218701. PubMed PMID: 31233522.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Influence of orbital morphology on proptosis reduction and ocular motility after decompression surgery in patients with Graves' orbitopathy. AU - Oeverhaus,Michael, AU - Copei,Anna, AU - Mattheis,Stefan, AU - Ringelstein,Adrian, AU - Tiemessen,Madeleine, AU - Esser,Joachim, AU - Eckstein,Anja, AU - Stähr,Kerstin, Y1 - 2019/06/24/ PY - 2018/03/27/received PY - 2019/06/08/accepted PY - 2019/6/25/entrez PY - 2019/6/25/pubmed PY - 2019/6/25/medline SP - e0218701 EP - e0218701 JF - PloS one JO - PLoS ONE VL - 14 IS - 6 N2 - PURPOSE: Orbital decompression surgery is performed in patients with Graves' orbitopathy to treat dysthyroid optical neuropathy (DON) and reduce disfiguring proptosis. The intended proptosis reduction can deviate from the postoperative result and changes of motility with consecutive diplopia can occur. We performed a retrospective study to identify anatomical factors in computed tomography (CT), which influence the surgical effect and postoperative ocular motility and diplopia. METHODS: Pre- and postoperative CT-scans of 125 eyes of 68 patients, who mainly underwent a balanced orbital decompression for disfiguring proptosis (≥18mm Hertel Index), have been analyzed. Proptosis, ductions, misalignment and diplopia were assessed before and after surgery. Medial and lateral orbital wall length, conus angle, depth of ethmoidal sinus, orbital surface, length of medial and orbital defect, depth of tissue prolapse and horizontal muscle diameters were analyzed in CT scans before and after surgery. With linear regression and multivariate analyses these parameters have been correlated with postoperative proptosis, abduction deficit, deviation and binocular single vision (BSV). RESULTS: Proptosis could be reduced by 5.3±2mm. Patients with <5mm proptosis reduction had significantly less often new onset of diplopia compared to patients with >5mm reduction (13% vs. 56%, p = 0.02). Multiple linear regression showed a significant correlation between tissue prolapse and depth of the ethmoidal sinus as well as age (p<0.001, r = 0.71). Proptosis reduction could not be predicted by tissue prolapse, defect length or depth of ethmoidal sinus. The abduction deficit correlated significantly with tissue prolapse and orbital surface area (p<0.001, r = 0.37) but not with the horizontal muscle diameter. CONCLUSION: We were able to show that orbital morphology influences the outcome of balanced orbital decompression surgery in terms of proptosis reduction and motility. However, the rather low coefficients of correlation show that the surgical outcome cannot be predicted with simple CT measurements, although risk factors for postoperative abduction deficit could be found. Therefore, preoperative planning should consider especially the orbital surface area and depth of ethmoidal sinus. Patients should be informed about the higher risk of diplopia with higher proptosis reduction. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31233522/Influence_of_orbital_morphology_on_proptosis_reduction_and_ocular_motility_after_decompression_surgery_in_patients_with_Graves'_orbitopathy L2 - http://dx.plos.org/10.1371/journal.pone.0218701 DB - PRIME DP - Unbound Medicine ER -