Korean J Ophthalmol.  2016 Apr;30(2):85-91. 10.3341/kjo.2016.30.2.85.

Surgical Outcomes of Balanced Deep Lateral and Medial Orbital Wall Decompression in Korean Population: Clinical and Computed Tomography-based Analysis

• Choi SU
• Kim KW
• Lee JK

• KMID: 2160457
• DOI: http://doi.org/10.3341/kjo.2016.30.2.85

Abstract

PURPOSE
To evaluate the clinical outcomes of balanced deep lateral and medial orbital wall decompression and to estimate surgical effects using computed tomography (CT) images in Korean patients with thyroid-associated ophthalmopathy (TAO).
METHODS
Retrospective chart review was conducted in TAO patients with exophthalmos who underwent balanced deep lateral and medial orbital wall decompression. Exophthalmos was measured preoperatively and postoperatively at 1 and 3 months. Postoperative complications were evaluated in all study periods. In addition, decompressed bone volume was estimated using CT images. Thereafter, decompression volume in each decompressed orbital wall was analyzed to evaluate the surgical effect and predictability.
RESULTS
Twenty-four patients (48 orbits) with an average age of 34.08 ± 7.03 years were evaluated. The mean preoperative and postoperative exophthalmos at 1 and 3 months was 18.91 ± 1.43, 15.10 ± 1.53, and 14.91 ± 1.49 mm, respectively. Bony decompression volume was 0.80 ± 0.29 cm3 at the medial wall and 0.68 ± 0.23 cm3 at the deep lateral wall. Postoperative complications included strabismus (one patient, 2.08%), upper eyelid fold change (four patients, 8.33%), and dysesthesia (four patients, 8.33%). Postsurgical exophthalmos reduction was more highly correlated with the deep lateral wall than the medial wall.
CONCLUSIONS
In TAO patients with exophthalmos, balanced deep lateral and medial orbital wall decompression is a good surgical method with a low-risk of complications. In addition, deep lateral wall decompression has higher surgical predictability than medial wall decompression, as seen with CT analysis.

Keyword

Computed tomography; Exophthalmos reduction; Graves ophthalmopathy; Orbital decompression

MeSH Terms

Decompression*
Exophthalmos
Eyelids
Graves Ophthalmopathy
Humans
Orbit*
Paresthesia
Postoperative Complications
Retrospective Studies
Strabismus
Troleandomycin
Troleandomycin

Figure

• 

  Fig. 1 Hertel value at preoperative and postoperative 1 and 3 months (*paired t-test, **paired t-test).

• 

  Fig. 2 Partial correlation analysis of decompression volume in medial wall (A) and deep lateral wall (B) with postsurgical exophthalmos reduction. Partial correlation coefficient (partial R) which represent surgical predictability, was higher in deep lateral orbital wall decompression (B, partial R = 0.487) than medial orbital wall decompression (A, partial R = 0.402. *p = 0.002, **p = 0.011).

Reference

1. Wiersinga WM, Smit T, van der Gaag R, et al. Clinical presentation of Graves' ophthalmopathy. Ophthalmic Res. 1989; 21:73–82.

2. McCord CD Jr. Current trends in orbital decompression. Ophthalmology. 1985; 92:21–33.

3. Trokel SL, Jakobiec FA. Correlation of CT scanning and pathologic features of ophthalmic Graves' disease. Ophthalmology. 1981; 88:553–564.

4. Heufelder AE. Pathogenesis of ophthalmopathy in autoimmune thyroid disease. Rev Endocr Metab Disord. 2000; 1:87–95.

5. Lyons CJ, Rootman J. Orbital decompression for disfiguring exophthalmos in thyroid orbitopathy. Ophthalmology. 1994; 101:223–230.

6. Unal M, Leri F, Konuk O, Hasanreisoglu B. Balanced orbital decompression combined with fat removal in Graves ophthalmopathy: do we really need to remove the third wall? Ophthal Plast Reconstr Surg. 2003; 19:112–118.

7. Graham SM, Brown CL, Carter KD, et al. Medial and lateral orbital wall surgery for balanced decompression in thyroid eye disease. Laryngoscope. 2003; 113:1206–1209.

8. Baldeschi L, MacAndie K, Hintschich C, et al. The removal of the deep lateral wall in orbital decompression: its contribution to exophthalmos reduction and influence on consecutive diplopia. Am J Ophthalmol. 2005; 140:642–647.

9. Ben Simon GJ, Syed HM, Lee S, et al. Strabismus after deep lateral wall orbital decompression in thyroid-related orbitopathy patients using automated hess screen. Ophthalmology. 2006; 113:1050–1055.

10. Kim KW, Byun JS, Lee JK. Surgical effects of various orbital decompression methods in thyroid-associated orbitopathy: computed tomography-based comparative analysis. J Craniomaxillofac Surg. 2014; 42:1286–1291.

11. European Group on Graves' Orbitopathy (EUGOGO). Mourits MP, Bijl H, et al. Outcome of orbital decompression for disfiguring proptosis in patients with Graves' orbitopathy using various surgical procedures. Br J Ophthalmol. 2009; 93:1518–1523.

12. Goldberg RA, Perry JD, Hortaleza V, Tong JT. Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy. Ophthal Plast Reconstr Surg. 2000; 16:271–277.

13. Kacker A, Kazim M, Murphy M, et al. "Balanced" orbital decompression for severe Graves' orbitopathy: technique with treatment algorithm. Otolaryngol Head Neck Surg. 2003; 128:228–235.

14. Fayers T, Barker LE, Verity DH, Rose GE. Oscillopsia after lateral wall orbital decompression. Ophthalmology. 2013; 120:1920–1923.

15. Goldberg RA, Shorr N, Cohen MS. The medical orbital strut in the prevention of postdecompression dystopia in dysthyroid ophthalmopathy. Ophthal Plast Reconstr Surg. 1992; 8:32–34.

16. Wu CH, Chang TC, Liao SL. Results and predictability of fat-removal orbital decompression for disfiguring graves exophthalmos in an Asian patient population. Am J Ophthalmol. 2008; 145:755–759.

17. Mehta P, Durrani OM. Outcome of deep lateral wall rim-sparing orbital decompression in thyroid-associated orbitopathy: a new technique and results of a case series. Orbit. 2011; 30:265–268.

18. Goldberg RA, Kim AJ, Kerivan KM. The lacrimal key-hole, orbital door jamb, and basin of the inferior orbital fissure: three areas of deep bone in the lateral orbit. Arch Ophthalmol. 1998; 116:1618–1624.

19. Beden U, Edizer M, Elmali M, et al. Surgical anatomy of the deep lateral orbital wall. Eur J Ophthalmol. 2007; 17:281–286.

20. Adenis JP, Robert PY, Lasudry JG, Dalloul Z. Treatment of proptosis with fat removal orbital decompression in Graves' ophthalmopathy. Eur J Ophthalmol. 1998; 8:246–252.

21. Alsuhaibani AH, Carter KD, Policeni B, Nerad JA. Orbital volume and eye position changes after balanced orbital decompression. Ophthal Plast Reconstr Surg. 2011; 27:158–163.

22. Lefebvre DR, Yoon MK. CT-based measurements of the sphenoid trigone in different sex and race. Ophthal Plast Reconstr Surg. 2015; 31:155–158.