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Endocrine exophthalmos and controversial methods of orbital decompression

https://doi.org/10.21516/2072-0076-2016-9-4-37-45

Abstract

In cases of severe endocrine ophthalmopathy, conservative therapy often fails to produce satisfactory results. Therefore, surgical treatment is used, in particular orbit decompression, which triggers controversial opinions in the literature. Purpose: to present the authors’ own method of orbital decompression, clinical observations, and the results achieved over 30 years of experience. Material and methods. 119 patients aged 17-73 with severe endocrine ophthalmopathy were operated in accordance with the authors’ technique of orbital decompression. In the course of these operations, three walls of the orbit are partially resected, periorbital, intraorbital and retrobulbar fat is removed, eyelids are simultaneously corrected for deformities and retracted. Results. After the operation, all patients showed a significant reduction of exophthalmos (by 5-11 mm, averagely 7 mm), and IOP, a marked improvement in extraocular muscle functions, and considerable reduction or disappearance of subjective symptoms. Vision acuity improved in 68 % patients. Mild relapse of exophtalmos was noted in three cases only, and only one patient required a repeated unilateral operation. Strabismus surgery had to be performed in 6 patients (5 %) due to correction of residual double vision. Conclusion. It can thus be concluded that our method or orbital decompression gives very good functional and aesthetic long-term results // Russian Ophthalmological Journal, 2016; 4: 37-45 . doi: 10.21516/2072-0076-2016-9-4-37-45.

About the Authors

R. P. Roncevic
Clinic for plastic and reconstructive surgery
Russian Federation


Z. . Savkovic
Revida Eye hospital
Russian Federation


R. T. Nigmatullin
Russian Eye and Plastic Surgery Center
Russian Federation


References

1. Dollinger J. Die Druckenlastung der Augenhohle durch Entfernung der aussern Orbitawand bei hochgradigem Exophtalmus (Morbus Basedowi) und konsekutiver Hornhauterkrankung. Dtch. Med. Wochenschr. 1911; 37: 1888-90.

2. Hirsch V.O., Urbaneck J. Behandlung eines exzessiven Exophtalmus (Basedow) durch Entfernung von Orbitalfelt von der Kieferhole. Monatsschr Ohrheilkd Laryngorhinol. 1930; 64: 212-3.

3. Naffziger H.C. Progressive exophthalmos following thyroidectomy: its pathology and treatment Ann. Surg. 1931; 94: 582-6.

4. Sewell E.C. Operative control of progressive exophtalmos. Arch. Otolaryngol. 1936; 24: 621-33.

5. Walsh T.E., Ogura J.H. Transantral orbital decompression for malignant exophtalmos. Laryngoscope. 1957; 64: 544-68.

6. Tessier P. Les exophtalmies. Expansion chirurgicale de l’orbite. Ann. Chir. Plast. 1969; 14: 207-14.

7. Wolfe S.A. Modified three - wall orbital expansion to correct persistent exophtalmos or exorbitism. Plast. Reconstr. Surg. 1979; 64: 448-55.

8. Anderson R.L., Lindberg J.V. Transantral approach to decompression in Graves disease. Ophtalmol. 1981; 99: 120-4.

9. Kennerdell J.S., Maroon J.C. An orbital decompression for severe dysthyroid exophtalmos Ophtalmology. 1982; 89: 467 - 472.

10. Bartalena L., Marcocci I., Bogazzi F., Panicuscu M., Bruno-Bossio G. Orbital decompression for severe Graves ophthalmopathy. Results of a three-wall operative technique. J. Neurosurg. Sci. 1989; 33(4): 323-7.

11. Krastinova - Lolov D., Bach C.A., Hartl D.M., et al. Surgical strategy in the treatment of globe protrusion depending on its mechanism (Graves Disease, nonsyndromic exorbitism, or high myopia). Plast. Reconstr. Surg. 2006; 117: 553-64.

12. Rončević R. Surgical strategy in the treatment of globe protrusion depending on its mechanism. Plast Reconstr Surg. 2006; 118(7): 1660-2.

13. Rončević R. Correction of exophthalmos and eyelid deformities in patients with severe thyroid ophthalmopathy, experience for 20 years. J. Craniogacial Surg. 2008; 19: 628-36.

14. Rončević R. Hirurgija očne duplje. Zavod za udžbenike i nastavna sredstva. Beograd; 2003; 80-106.

15. Rončević R., Jackson I.T. Surgical treatment of thyrotoxic exophthalmos. Plast. Reconstr. Surg. 1989; 84: 754-60.

16. Rončević R., Rončević D. Surgical treatment of severe dysthyroid ophtalmopathy, long term results J. Craniomaxillofac. Surg. 1995; 23: 355-62.

17. Roncevic R., Savkovic Z., Roncevic D. Results of diplopia and strabismus in patients with severe thyroid ophthalmopathy after orbital decompression. Indian J. Ophthalmol. 2014; 62: 266-73.

18. Бровкинa А.Ф. Болезни орбиты. Москва: МИА; 2008: 198-219.

19. Реброва О.Ю. Статистический анализ медицинских данных. Применение пакета прикладных программ STATISTICA. Москва: Медиасфера; 2002.

20. Adenis J.P., Camezind P; Robert P.Y. Is incidence of diplopia after fat removal orbital decompression predictive factor of choice of surgical technique for Graves ophthalmopathy. Bull. Acad. Natl. Med. 2003; 187: 1649-58.

21. Baldeshi L. Small versus coronal incision of orbital decompression in Graves’ orbitopathy. Orbit 2009; 28: 231-6.

22. Baldeshi L., Boshi A. Orbital decompression in thyroid eye disease. In: Medel L.,Vasquez L.M., eds. Orbital surgery. Basel: Karger; 2014: 18-33.

23. Mourits M.P., Bijl H., Altea M.A., et al. Outcome of orbital decompression for disfiguring proptosis in patients with Graves’ orbitopathy using various surgical procedures. Br. J. Ophthalmol. 2009; 93: 1518-23.

24. Morax S., Hurbli T. Choice of surgical treatment for Graves disease. J. Craniomaxillofac. Surg. 1987; 15: 174-81.

25. Olivari N. Transpalbebral decompression of endocrine ophthalmopathy (Graves disease) by removal of intraorbital fat. Plast. Reconstr. Surg. 1991; 87: 621-41.

26. McCord C.D.Jr. Current trends in orbital decompression. Ophtalmology. 1985; 92: 21-23.

27. Shorr N., Neuhaus R.W., Baylis H.I. Ocular motility problems after orbital decompression for dysthyroid ophtalmopathy. Ophtalmology 1982; 89: 323-8.

28. Bartalena L., Baldeshi L., Dickinson A.J. et al. Concesus statement of European group on Graves’ orbitopathy (EUGOGO) on management of Graves’ orbitopathy. Thyroid. 2008; 18: 333-46.

29. Leone C.R. Jr., Piest K.L., Newman R.J. Medial and lateral wall decompression for thyroid ophthalmopathy. Am. J. Ophtalmol. 1989; 108: 160-6.

30. Pearl R.M., Vistenes L., Troxel S. Treatment of exophthalmos. Plast. Reconstr. Surg. 1991; 87: 236-44.

31. Waller R.R., De Santo L.W., Anderson R.I. Management of thyroid ophthalmopathy. In: Smith B.C. Ophthalmic Plastic and Reconstructive Surgery. Mosby, St. Louis; 1987: 1369-92.

32. De Santo L.W. The total rehabilitation of Graves disease. Laringoscope. 1980; 90: 1652-78.

33. Garrity J.A., Fatourechi V., Bergstralh E.J., et al. Results of transantral orbital decompression in 428 patients with severe Graves’ orbitopathy. Am. J. Ophthalmol. 1993; 116: 533-47.

34. Kasperbauer J.L., Hinkley L. Endoscopic orbital decompression for Graves ophthalmopathy. Am. J. Rhinology. 2005; 19: 603-6.


Review

For citations:


Roncevic R.P., Savkovic Z., Nigmatullin R.T. Endocrine exophthalmos and controversial methods of orbital decompression. Russian Ophthalmological Journal. 2016;9(4):37-45. (In Russ.) https://doi.org/10.21516/2072-0076-2016-9-4-37-45

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ISSN 2072-0076 (Print)
ISSN 2587-5760 (Online)