28. Effects of orbital decompression by endoscopic endonasal in thyroid eye disease
Main Article Content
Abstract
This is a prospective study aimed to assess the efficacy of endoscopic orbital decompression in thyroid eye disease and to study some influencing factors. From January 2018 to December 2021, the study enrolled 65 orbits of 42 patients who underwent endoscopic orbital decompression. Indications for surgery were proptosis in 34 orbits and compressive optic neuropathy in 31 orbits. The results showed an average reduction in exophthamos of 2.02 ± 1.06 mm (1 - 4mm) in proptosis group. Visual acuity improvement in compressive optic neuropathy group was equivalent to 3.1 Snellen lines. Complications were observed in 6 cases with significant bleeding, 2 cases sinusitis and 1 orbital contamination better postoperative visual acuity was significantly correlated with better preoperative visual acuity. Greater reduction of exophthamos was significantly correlated with greater preoperative exophthamos. Preservation of orbital strut along with lower incidence of double vision and smaller reduction of exophthamos.
Article Details
Keywords
endoscopic orbital decompression, thyroid eye disease
References
2. Bartalena L, Piantanida E, Gallo D, Lai A, Tanda ML. Epidemiology, Natural History, Risk Factors, and Prevention of Graves’ Orbitopathy. Frontiers in endocrinology. 2020;11:615993. doi: 10.3389/fendo.2020.615993.
3. Gioacchini FM, Kaleci S, Cassandro E, et al. Orbital wall decompression in the management of Graves’ orbitopathy: A systematic review with meta-analysis. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. Nov 2021;278(11):4135-4145. doi: 10.1007/s00405-021-06698-5.
4. Pletcher SD, Sindwani R, Metson R. Endoscopic orbital and optic nerve decompression. Otolaryngologic clinics of North America. Oct 2006;39(5):943-58, vi. doi: 10.1016/j.otc.2006.06.003.
5. She YY, Chi CC, Chu ST. Transnasal endoscopic orbital decompression: 15-year clinical experience in Southern Taiwan. Journal of the Formosan Medical Association. Sep 2014;113(9):648-55. doi: 10.1016/j.jfma.2012.08.009.
6. Woods RSR, Pilson Q, Kharytaniuk N, Cassidy L, Khan R, Timon CVI. Outcomes of endoscopic orbital decompression for graves’ ophthalmopathy. Irish journal of medical science. Feb 2020;189(1):177-183. doi: 10.1007/s11845-019-02043-2.
7. Gulati S, Ueland HO, Haugen OH, Danielsen A, Rodahl E. Long-term follow-up of patients with thyroid eye disease treated with endoscopic orbital decompression. Acta ophthalmologica. Mar 2015;93(2):178-83. doi: 10.1111/aos.12469.
8. Yuen AP, Kwan KY, Chan E, Kung AW, Lam KS. Endoscopic transnasal orbital decompression for thyrotoxic orbitopathy. Hong Kong medical journal. Dec 2002;8(6):406-10.
9. Nguyễn Chiến Thắng. Nghiên cứu ứng dụng phẫu thuật giảm áp hốc mắt điều trị bệnh mắt Basedow mức độ nặng. Luận án tiến sĩ y học, Trường Đại học Y Hà Nội; 2014.
10. Currò N, Covelli D, Vannucchi G, et al. Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Thyroid: official journal of the American Thyroid Association. May 2014;24(5):897-905. doi: 10.1089/thy.2013.0445.
11. Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC. Graves’ Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management. Journal of Ophthalmology. 2015;2015:249125. doi: 10.1155/2015/249125.
12. Kasperbauer JL, Hinkley L. Endoscopic orbital decompression for Graves’ ophthalmopathy. American journal of rhinology. Nov-Dec 2005;19(6):603-6.
13. Finn AP, Bleier B, Cestari DM, et al. A retrospective review of orbital decompression for Thyroid Orbitopathy with Endoscopic Preservation of the Inferomedial Orbital Bone Strut. Ophthalmic plastic and reconstructive surgery. 2017;33(5):334-339. doi: 10.1097/iop.0000000000000782.
14. Minasyan L, Zangwill L, Kikkawa DO. Risk factors associated with double vision after orbital decompression in patients with Thyroid-Related Orbitopathy (TRO). Investigative Ophthalmology & Visual Science. 2010;51(13):3920-3920.
15. Rajabi MT, Ojani M, Esfahani HR, Tabatabaei SZ, Rajabi MB, Hosseini SSJJoCO. Correlation of peripapillary nerve fiber layer thickness with visual outcomes after decompression surgery in subclinical and clinical thyroid-related compressive optic neuropathy. J Curr Ophthalmol. 2018;31(1):86-91.
16. Liang Q-W, Yang H, Luo W, He J-F, Du YJM. Effect of orbital decompression on dysthyroid optic neuropathy: A retrospective case series. Medicine (Baltimore). 2019;98(3).
17. Neigel JM, Rootman J, Belkin RI, et al. Dysthyroid optic neuropathy. The crowded orbital apex syndrome. Ophthalmology. Nov 1988;95(11):1515-21. doi: 10.1016/s0161-6420(88)32978-7.
18. Dolman PJ. Dysthyroid optic neuropathy: Evaluation and management. Journal of endocrinological investigation. Mar 2021;44(3):421-429. doi: 10.1007/s40618-020-01361-y.
19. Borumandi F, Hammer B, Kamer L, von Arx G. How predictable is exophthalmos reduction in Graves’ orbitopathy? A review of the literature. Br J Ophthalmol. Dec 2011;95(12):1625-30. doi: 10.1136/bjo.2010.181313.
20. Thapa S, Gupta AK, Gupta A, Gupta V, Dutta P, Virk RS. Proptosis reduction by clinical vs radiological modalities and medial vs inferomedial approaches: Comparison following endoscopic transnasal orbital decompression in patients with dysthyroid orbitopathy. JAMA otolaryngology-- head & neck surgery. Apr 2015;141(4):329-34. doi: 10.1001/jamaoto.2014.3659.