Long-term Result of Fat Orbital Decompression

Ji-Hye Park; Tae Soo Lee; Kyu Mee Kay

doi:10.3341/jkos.2010.51.4.473

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Park, Lee, and Kay: Long-term Result of Fat Orbital Decompression

Original Article

J Korean Ophthalmol Soc 2010;51(4):473-478.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.473

Long-term Result of Fat Orbital Decompression

Ji-Hye Park, MD, Tae Soo Lee, MD, PhD, Kyu Mee Kay, MD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Tae Soo Lee, MD, PhD Department of Ophthalmology, Korea Medical Center Guro Hospital #97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580, E-mail: tsoooo@hanmail.net

Received 21 September 2009 Accepted 7 January 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term results of orbital fat decompression with or without lateral wall decompression in Grave's ophthalmopathy.

Methods

The authors studied retrospectively the 24 thyroid-related orbitopathy patients (32 eyes) who had undergone fat removal decompression or combined orbital decompression (lateral wall decompression with fat removal) based on average exophthalmometric values for Koreans. The patients were followed for over six months postoperatively, from December 2000 to December 2008.

Results

The average amount of exophthalmos reduction was 4.13±2.60 mm in the fat removal decompression group and 5.79±2.02 mm in the combined orbital decompression group, respectively (p＜0.001). The final postoperative BCVA (best corrected visual acuity) in patients with compressive optic neuropathy improved in all cases. Intraocular pressure decreased significantly in all groups after operation (p＜0.001). Except for one patient who had newly onset diplopia, which was transient, no patient's diplopia worsened.

Conclusions

The authors obtained excellent surgical results in the treatment of orbital decompression and cosmesis without complications that can result from fat removal decompression or combined orbital decompression.

Keywords: Exophthalmos, Fat decompression, Orbital decompression, Thyroid-related orbitopathy

References

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Figure 1.

Lateral wall sculpting using a high speed rotating diamond burr.

Figure 2.

Removed orbital fat.

Figure 3.

(Left) Exophthalmos of the right eye is noted preoperatively. (Right) Exophthalmos is significantly reduced by lateral wall and fat decompression of the right eye.

Figure 4.

Pre-(left) and post-operative (right) orbit CT scans show a reduction of exophthalmos of the right orbit.

Table 1.

Classification of patients by amount of preop Hertel value of exophthalmos

	Number (Orbit)	Gender (M:F)	Mean age (yr^*)	Duration (mon^†)	F/U^‡ (mon^†)
Group1	14 (20)	5:9	37.75±11.39	12.85±9.25	25.25±13.75
Group2	10 (12)	3:7	38.25±9.95	12.67±9.19	22.33±10.99

^* yr=year

^† mon=month

^‡ F/u=follow-up.

Table 2.

Results of surgical decompression, visual acuity, and intraocular pressure

	Group 1	Group 2
Preoperative proptosis (mm)	21.93±3.23	23.08±2.58
Postoperative proptosis (mm)	17.80±2.57	17.29±1.86
p-value^‡	<0.001	<0.001
Fat removal amount (ml)	4.85±2.12	4.12±2.06
Decreased proptosis (mm)	4.13±2.60	5.79±2.02
Preoperative BCVA^* (log MAR)	0.29±0.31	0.31±0.44
Postoperative BCVA^* (log MAR)	0.25±0.25	0.29±0.43
p-value^‡	0.154	0.882
Preoperative IOP^† (mmHg)	18.30±4.24	16.25±1.91
Postoperative IOP^† (mmHg)	16.25±3.09	13.75±1.22
p-value^‡	<0.001	<0.001

^* BCVA=best corrected visual acuity

^† IOP=intraocular pressure

^‡ Paired t-test.

Table 3.

Visual field changes in each group

	Improved	No change	Aggravated
Group1	7 (35.0%)	12 (63.2%)	1^*
Group2	4 (33.3%)	8 (66.7%)	0

^* Due to transient diplopia.

Table 4.

Diplopia changes in each group

	Preoperative diplopia	New-onset diplopia	Improved	No change	Aggravated
Group 1	4 (20.0%)	1^*	3	16	0
Group 2	4 (33.3%)	0	3	9	0

^* Transient diplopia.

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