Strabismus after Deep Lateral Wall Orbital Decompression in Thyroid-Related Orbitopathy Patients Using Automated Hess Screen

doi:10.1016/j.ophtha.2006.02.015

Ophthalmology

Volume 113, Issue 6, June 2006, Pages 1050-1055

https://doi.org/10.1016/j.ophtha.2006.02.015 Get rights and content

Purpose

To evaluate the effect of deep lateral wall orbital decompression with intraconal fat debulking on strabismus in thyroid-related orbitopathy (TRO) patients using automated Hess screen (AHS).

Design

Prospective nonrandomized clinical study.

Participants

Eleven TRO patients (19 surgeries) operated on at the Jules Stein Eye Institute from January, 2004, through December, 2004.

Methods

Automated Hess screen testing was performed in all patients before surgery and 3 months after surgery; all patients received surgery in the nonactive phase of the disease.

Main Outcome Measures

Amplitude of horizontal and vertical deviations (prism diopters) in all standard positions of gaze.

Results

Eleven TRO patients (7 females; mean age, 47 years) were included in the study; 8 patients underwent bilateral surgery. After surgery, exophthalmos decreased an average (±standard deviation) of 2.7 mm (±2.5 mm; P = 0.003). Before surgery, 7 patients (63%) reported primary gaze diplopia, whereas only 2 patients (18%) showed diplopia in primary gaze after surgery (P = 0.03, chi-square analysis). Orbital decompression had no statistically significant effect on horizontal and vertical ocular deviations measured by AHS. Mean amplitude of deviation in primary gaze was 1.2 prism diopters (PD) esotropia and 0.07 PD hypotropia before surgery, and 2.5 PD exotropia with 0.6 PD hypertropia after surgery (δ = 3.7 PD for horizontal deviation and −0.7 for vertical deviation; P = 0.051, paired samples t test for horizontal difference and P not significant for vertical difference). Nonsignificant P values were obtained in all 9 positions of gaze. Most patients had periocular numbness that resolved spontaneously 2 to 6 months after surgery.

Conclusions

Deep lateral wall orbital decompression with intraconal fat debulking had no statistically significant effect on horizontal and vertical deviations measured by the AHS. Patients may demonstrate small angle exotropia shift, but this finding was not clinically significant.

Section snippets

Patients and Methods

We evaluated in a prospective fashion 11 consecutive TRO patients who were scheduled to undergo deep lateral wall orbital decompression with intraconal fat debulking at the Jules Stein Eye Institute from January, 2004, through December, 2004. Comprehensive eye examination was performed in all patients. Automated Hess screen testing was performed 2 to 4 weeks before surgery. All patients were operated on during the nonactive phase of the disease. The AHS test was repeated 3 months after surgery,

Results

Eleven TRO patients (7 females; mean age, 47 years) who underwent 19 deep lateral wall orbital decompressions with intraconal fat debulking surgeries were included in the study; 8 patients underwent bilateral surgery. After surgery, exophthalmos decreased an average (±standard deviation) of 2.7 mm (±2.5 mm; P = 0.003, Wilcoxon signed-rank test). Visual acuity remained unchanged after surgery (δ logarithm of the minimum angle of resolution visual acuity, 0.03; P = 0.2, one-sample t test; Table 1

Discussion

The current study shows that deep lateral wall orbital decompression with intraconal fat debulking had no statistical effect on horizontal and vertical ocular deviations measured by AHS testing. These results support our previous report¹⁵ and our assumption that minimal to no ocular shift occurs with this type of orbital decompression.

Automated Hess screen testing using a personal computer was found to be a viable alternative to electronic Hess screen testing and showed similar amplitudes of

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The effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid ophthalmopathy
2024, Journal Francais d'Ophtalmologie
To evaluate the effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy.
This retrospective study enrolled 55 eyes of 33 patients treated in our hospital for restrictive strabismus caused by thyroid-associated ophthalmopathy. We performed muscle recession for the obviously restricted extraocular muscles, with 6 weeks of follow-up. Surgical outcomes were compared between the orbital decompression group (DG, n = 15) and non-orbital decompression group (NDG, n = 18).
A total of 33 patients with Graves’ ophthalmopathy who underwent rectus muscle recession surgery were included. Of these, 15 patients had undergone orbital decompression prior to strabismus surgery, and 18 had not. The two groups did not differ in terms of the preoperative horizontal or vertical ocular deviation, degree of restriction of eye movement, degree of diplopia, or mean number of muscles that underwent surgery (P > 0.05). There was no significant difference in the preoperative horizontal or vertical ocular deviation, level of eye movement restriction, degree of diplopia and the success rate of the surgery (P > 0.05).
Rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy during the quiescent period could improve the ocular deviation and diplopia, and orbital decompression performed before strabismus surgery had no significant effect on surgical technique or outcomes of rectus muscle recession surgery.
Évaluer l’effet de la décompression orbitale sur l’effet curatif de la chirurgie de récession du muscle rectus de strabisme restrictif chez les patients atteints d’ophtalmopathie associée à la thyroïde.
Cette étude rétrospective a séléctionné 55 yeux de 33 patients traités dans notre hôpital pour strabisme restrictif en phase de repos causé par une ophtalmopathie associée à la thyroïde. Nous avons effectué la chirurgie de récession du muscle rectus pour les muscles extraoculaires manifestement restreints et le suivi pendant 6 semaines après la chirurgie. Les patients ont été divisés en un groupe de décompression orbitale (DG, n = 15) et un groupe de décompression non orbitale (NDG, n = 18) selon qu’ils avaient ou non des antécédents de chirurgie de décompression orbitale avant une chirurgie restrictive du strabisme, et le résultat de la chirurgie a été comparé entre ces deux groupes.
Trente-trois patients atteints d’ophtalmopathie ont subi une chirurgie de récession musculaire du rectus. Parmi ceux-ci, 15 avaient subi une décompression orbitale avant l’intervention chirurgicale du strabisme et 18 patients ne l’avaient pas fait. Les deux groupes ne différaient pas en termes de déviation oculaire horizontale et verticale préopératoire, de niveau de restriction des mouvements oculaires, de degré de diplopie ou de nombre moyen de muscles ayant subi une intervention chirurgicale (p > 0,05). Aucune différence significative n’a été observée en ce qui concerne l’écart oculaire horizontal ou vertical préopératoire, le niveau de restriction des mouvements oculaires, le degré de diplopie et le taux de réussite de l’opération (p > 0,05).
La chirurgie de récession du muscle rectus chez les patients atteints d’ophtalmopathie associée à la thyroïde pendant la période de repos pourrait améliorer la déviation, les mouvements oculaires et la diplopie, et la décompression orbitale effectuée avant la chirurgie du strabisme n’a eu aucun effet significatif sur la méthode chirurgicale et les résultats de la chirurgie de récession du muscle rectus.
Ocular motility changes after inferomedial wall and balanced medial plus lateral wall orbital decompression in Graves’ orbitopathy: A randomized prospective comparative study
2021, Clinics
Citation Excerpt :
To ensure accuracy, we performed routine qualitative clinical evaluations and a quantitative photographic method (16). In previous studies, neither technique was associated with late postoperative changes in versions (28,32). Patients who underwent IM-OD (but not ML-OD) experienced transient worsening of versions (abduction and elevation) in the early postoperative months, with similar findings reported in other studies (29).
To compare the surgical outcomes of inferomedial wall orbital decompression (IM-OD) and balanced medial plus lateral wall orbital decompression (ML-OD) in patients with inactive Graves' orbitopathy (GO) with regard to exophthalmos reduction and ocular motility abnormalities.
Forty-two patients with inactive GO eligible for OD were randomly assigned to either the IM-OD or ML-OD groups. Pre and postoperative evaluations included Hertel exophthalmometry, sensory, and motor extraocular motility assessment, standardized photographs in the nine gaze positions, and computed tomography (CT) of the orbits. ClinicalTrials.gov: NCT03278964.
Exophthalmometry reduction was statistically significant in both groups (p<0.001), but was greater in the ML-OD group (p=0.010). New-onset esotropia occurred in 11.1% and 23.5% of patients who underwent IM-OD and ML-OD, respectively, with no statistically significant difference in the frequency of pre and postoperative strabismus in either group. The mean increase in preoperative esotropia was 24±6.9 and 12±8.8 prism diopters in patients who underwent IM-OD and ML-OD, respectively. In the IM-OD group, abduction and elevation worsened at the first (p<0.05) and third (p<0.05) postoperative visits but were restored at 6 months. The versions did not change postoperatively with ML-OD. The preoperative CT-measured medial rectus muscle area predicted new-onset strabismus (p=0.023). Significant postoperative medial rectus muscle enlargement occurred in both groups (p<0.001). Restriction in elevation and abduction was significantly associated with enlarged inferior (p=0.007) and medial rectus muscle areas (p=0.002).
IM-OD is as safe as ML-OD with regard to new-onset strabismus, and represents a good alternative for patients who do not require significant exophthalmos reduction. ML-OD offers greater exophthalmos reduction and smoother postoperative recovery. Patients with preoperative enlarged medial rectus muscle on CT are at risk for new-onset esotropia, and preoperative esotropia is likely to increase after OD.
Orbital decompression for thyroid eye disease
2018, Survey of Ophthalmology
Citation Excerpt :
Deep lateral wall decompression ab interno without marginotomy has been reported to achieve on average between 2.7 mm and 4.0 mm of proptosis reduction.17,18,68,104,133,153,167 This can be accomplished via an eyelid crease,17,18 coronal,68 swinging eyelid,106 or lateral canthal133 approach. The incision and approach likely do not play a major role in the decompressive effect; however, addition of fat removal to this technique may improve decompression effect, with reports of proptosis reduction closer to 4.5 mm.68,167
The literature regarding orbital decompression for thyroid eye disease is vast, spanning multiple specialty areas including neurosurgery, head and neck, maxillofacial, and ophthalmic plastic surgery. Although techniques have advanced considerably over the more than 100 years during which this procedure has been performed, the 4 major approaches remain: transorbital, transcranial, transantral, and transnasal. The explosion in literature related to orbital decompression has mostly involved minor technical variations on broader surgical themes. The purpose of this review is to organize the major approaches in terms of bony anatomy and to contextualize variation in transdisciplinary techniques within a common conceptualization.
Orbital Decompression: Conceptual Approach for Orbital Volume Expansion
2023, Ophthalmic Plastic and Reconstructive Surgery
The effect of rim-off deep lateral orbital decompression on the lateral rectus shape and oculomotor balance
2023, International Ophthalmology
Postoperative residual vertical deviation affects quality of life in Asian patients with thyroid-associated ophthalmopathy (Graves ophthalmopathy)
2023, Japanese Journal of Ophthalmology

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Case ReportStrabismus after Deep Lateral Wall Orbital Decompression in Thyroid-Related Orbitopathy Patients Using Automated Hess Screen

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Reversal of dysthyroid optic neuropathy following orbital fat decompression

Br J Ophthalmol

Dysthyroid optic neuropathy. Clinical profile and rationale for management

Arch Ophthalmol

The risk of diplopia following orbital floor and medial wall decompression in subtypes of ophthalmic Graves’ disease

Ophthal Plast Reconstr Surg

The lacrimal keyhole, orbital door jamb, and basin of the inferior orbital fissurethree areas of deep bone in the lateral orbit

Arch Ophthalmol

Transconjunctival orbital decompression in Graves’ ophthalmopathylateral wall approach ab interno

Br J Ophthalmol

Case Report
Strabismus after Deep Lateral Wall Orbital Decompression in Thyroid-Related Orbitopathy Patients Using Automated Hess Screen