The Clinical Result of Medial Orbital Decompression in Patients with Thyroid-associated Orbitopathy

Na Ri Park; Jeong Kyu Lee

doi:10.3341/jkos.2019.60.11.1015

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Park and Lee: The Clinical Result of Medial Orbital Decompression in Patients with Thyroid-associated Orbitopathy

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(11): 1015-1020.

Published online: 19 October 2019

DOI: https://doi.org/10.3341/jkos.2019.60.11.1015

The Clinical Result of Medial Orbital Decompression in Patients with Thyroid-associated Orbitopathy

Na Ri Park, MD, Jeong Kyu Lee, MD, PhD

Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

Address reprint requests to Jeong Kyu Lee, MD, PhD. Department of Ophthalmology, Chung-Ang University Hospital, #102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea. Tel: 82-2-6299-1666, Fax: 82-2-6299-3231, lk1246@hanmail.net

Received 2 May 2019 Revised 26 June 2019 Accepted 24 October 2019

The Korean Ophthalmological Society

(open-access):

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 clinical effects of medial orbital decompression in patients with thyroid orbitopathy.

Methods

Forty-three orbits of 28 patients who underwent medial orbital decompression for cosmetic purposes between January 2014 to January 2017 were retrospectively reviewed. Changes in visual acuity, intraocular pressure, exophthalmos, strabismus, and diplopia were checked before, 3 months, and 1 year after surgery.

Results

The average exophthalmos reduction was −2.99 ± 0.96 mm at postoperative 3 months and −3.07 ± 1.24 mm after 1 year (both, p < 0.001). In patients who underwent unilateral orbital decompression, the mean difference in exophthalmometry between the two eyes was significantly reduced from 3.06 ± 0.78 mm to 0.38 ± 0.44 mm after 3 months, and to 0.50 ± 0.46 mm after 1 year (p = 0.011 and p = 0.012, respectively). After surgery, the final postoperative intraocular pressure decreased significantly at postoperative 3 months and 1 year (both, p < 0.001). The mean preoperative horizontal deviation was 0.88 ± 4.85 prism diopters (PD) and 5.50 ± 6.74 PD at postoperative 3 months, which demonstrated significant esodeviation postoperatively (p = 0.007). Three patients had new onset esotropia (8.33%), but no surgical treatment was needed.

Conclusions

Medial orbital decompression is a less invasive and safe surgical procedure for patients with asymmetric or mild thyroid-associated orbitopathy, which can be beneficial for reducing proptosis.

Keywords: Diplopia, Exophthalmos, Orbital decompression, Thyroid-associated orbitopathy

Figures and Tables

Table 1

Demographics of 28 thyroid-related orbitopathy patients who underwent medial orbital decompression

Values are presented as mean ± standard deviation or n (%).

Table 2

Clinical features of the patients with medial orbital decompression surgery

Values are presented as mean ± standard deviation.

IOP = intraocular pressure.

^*p < 0.05 by paired t-test, compared with preoperative.

Table 3

Eye deviations at preoperative and postoperative 3 months and 1 year

Values are presented as mean ± standard deviation. Positive values refer to esotropia, whereas negative values refer to exotropia.

PD = prism diopter.

^*p< 0.05 by Wilcoxon signed rank test, compared with preoperative; ^†all three patients underwent surgery for vertical strabismus within 7 months after orbital decompression.

Table 4

Characteristics of patients with strabismus before orbital decompression surgery

M = male; ET = esotropia; RHoT = right hypotropia; BMR = bilateral medial rectus muscle; RIR = right inferior rectus muscle; LHoT = left hypotropia; LMR = left medial rectus muscle; LIR = left inferior rectus muscle; RSR = right superior rectus muscle; LHT = left hypertropia; F = female; RHT = right hypertropia.

Table 5

Characteristics of patients with new-onset strabismus after orbital decompression surgery

ET = esotropia.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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