Outcomes of orbital decompression for thyroid eye disease over a 10-year period at a tertiary eye care referral center
Medical hypothesis, discovery & innovation in optometry,
Vol. 4 No. 3 (2023),
3 October 2023
,
Page 121-128
https://doi.org/10.51329/mehdioptometry181
Abstract
Background: Orbital decompression is frequently indicated to treat exophthalmos and compressive optic neuropathy, among other indications for thyroid eye disease (TED). This study aimed to evaluate the outcomes of orbital decompression and compare the results by urgency and type of surgery in patients with TED.Methods: In this cross-sectional study, we recruited patients with TED who had undergone emergency or elective orbital decompression surgery at a tertiary eye care referral center in Tehran, Iran, between 2010 and 2020. Ophthalmic examination findings, demographic and clinical profiles, and types and outcomes of surgical interventions were reviewed and analyzed.
Results: Fifty-one orbits of 35 patients with a mean (standard deviation [SD]) age of 36.2 (12.0) years and male-to-female ratio of 23 (66%)/12 (34%) were included. The mean (SD) duration from the diagnosis to the surgery was 41.0 (39.0) months. The surgical method was fat decompression in 1 (2%) orbit; fat and inferior wall decompressions in 2 (4%) orbits; fat, inferior, and medial wall (two-wall) decompressions in 43 (84%) orbits; and fat, inferior, medial, and lateral wall (three-wall) decompressions in five (10%) orbits. Three-wall decompression surgery resulted in significantly lower exophthalmometry readings than those associated with two-wall surgery at all postoperative follow-ups (P < 0.05). Ten (20%) orbits required emergency decompression because of sight-threatening conditions and revealed comparable exophthalmometry readings with electively decompressed orbits at the 1-year visit (P > 0.05). Thirty-seven (73%) orbits required other surgeries within the 1-year follow-up. The mean (SD) exophthalmometry readings before and 1-year after surgery were 26.3 (4.0) and 18.3 (2.7) mm, respectively, with a significant decrease and significant 5.5 (3.3)-mm change from baseline in decompressed orbits (both P < 0.001). Diplopia was reported in 29% (n = 10) of patients less than 2 months postoperatively.
Conclusions: Emergency or elective orbital decompression significantly reduced exophthalmos in patients with TED within 1 year postoperatively. Three-wall orbital decompression produced the more immediate impact, while two-wall orbital decompression showed the higher effect at a later timepoint. The most common complication was diplopia, while other serious complications occurred infrequently. Further prospective comparative studies involving more participants and longer postoperative follow-up periods are required to verify these preliminary findings.
Keywords:
- surgical decompression
- Graves orbitopathy
- thyroid eye diseases
- optic neuropathy
- visual acuities
- diplopias
- double vision
- elective surgical procedure
References
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15. Rajabi MT, Tabary M, Baharnoori S, Salabati M, Mahmoudzadeh R, Hosseinzadeh F, et al. Orbital anatomical parameters affecting outcome of deep lateral orbital wall decompression. Eur J Ophthalmol. 2021;31(4):2069-2075. doi: 10.1177/1120672120941433 pmid: 32627588
16. Victores AJ, Takashima M. Thyroid Eye Disease: Optic Neuropathy and Orbital Decompression. Int Ophthalmol Clin. 2016;56(1):69-79. doi: 10.1097/IIO.0000000000000101 pmid: 26626933
17. Saeed P, Tavakoli Rad S, Bisschop PHLT. Dysthyroid Optic Neuropathy. Ophthalmic Plast Reconstr Surg. 2018;34(4S Suppl 1):S60-S67. doi: 10.1097/IOP.0000000000001146 pmid: 29927882
18. Pelewicz M, Rymuza J, Pelewicz K, Mi?kiewicz P. Dysthyroid Optic Neuropathy: Treatment with Additional Intravenous Methylprednisolone Pulses after the Basic Schedule Is Associated with Stabilization or Further Improvement of Clinical Outcome. J Clin Med. 2022;11(8):2068. doi: 10.3390/jcm11082068 pmid: 35456161
19. Tagami M, Honda S, Azumi A. Insights into Current Management Strategies for Dysthyroid Optic Neuropathy: A Review. Clin Ophthalmol. 2022;16:841-850. doi: 10.2147/OPTH.S284609 pmid: 35330749
20. Fichter N, Guthoff RF, Schittkowski MP. Orbital decompression in thyroid eye disease. ISRN Ophthalmol. 2012;2012:739236. doi: 10.5402/2012/739236 pmid: 24558591
21. Verity DH, Rose GE. Acute thyroid eye disease (TED): principles of medical and surgical management. Eye (Lond). 2013;27(3):308-19. doi: 10.1038/eye.2012.284 pmid: 23412559
22. Sellari-Franceschini S, Rocchi R, Marinò M, Bajraktari A, Mazzi B, Fiacchini G, et al. Rehabilitative orbital decompression for Graves’ orbitopathy: results of a randomized clinical trial. J Endocrinol Invest. 2018;41(9):1037-1042. doi: 10.1007/s40618-018-0847-7 pmid: 29450866
23. Ye Y, Hu F, Ji Y, Wang R, Zhu K, Kong Q. The outcomes of endoscopic orbital decompression combined with fat decompression for thyroid-associated ophthalmopathy. BMC Ophthalmol. 2023;23(1):217. doi: 10.1186/s12886-023-02957-7 pmid: 37193956
24. Hain?ro?ie R, Ioni?? I, Pietro?anu C, Pi?uru S, Hain?ro?ie M, Zainea V. Transnasal endoscopic orbital decompression. Rom J Ophthalmol. 2017;61(3):192-195. doi: 10.22336/rjo.2017.35 pmid: 29450397
25. O’Malley MR, Meyer DR. Transconjunctival fat removal combined with conservative medial wall/floor orbital decompression for Graves orbitopathy. Ophthalmic Plast Reconstr Surg. 2009;25(3):206-10. doi: 10.1097/IOP.0b013e3181a424cc pmid: 19454932
26. DeParis SW, Tian J, Rajaii F. Practice Patterns in Orbital Decompression Surgery Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members. Ophthalmol Ther. 2019;8(4):541-548. doi: 10.1007/s40123-019-00206-z pmid: 31422554
27. Jernfors M, Välimäki MJ, Setälä K, Malmberg H, Laitinen K, Pitkäranta A. Efficacy and safety of orbital decompression in treatment of thyroid-associated ophthalmopathy: long-term follow-up of 78 patients. Clin Endocrinol (Oxf). 2007;67(1):101-7. doi: 10.1111/j.1365-2265.2007.02845.x pmid: 17466006
2. Ben Simon GJ, Katz G, Zloto O, Leiba H, Hadas B, Huna-Baron R. Age differences in clinical manifestation and prognosis of thyroid eye disease. Graefes Arch Clin Exp Ophthalmol. 2015;253(12):2301-8. doi: 10.1007/s00417-015-3156-2 pmid: 26344731
3. Boboridis KG, Bunce C. Surgical orbital decompression for thyroid eye disease. Cochrane Database Syst Rev. 2011;(12):CD007630. doi: 10.1002/14651858.CD007630.pub2 pmid: 22161415
4. Kossler AL, Douglas R, Dosiou C. Teprotumumab and the Evolving Therapeutic Landscape in Thyroid Eye Disease. J Clin Endocrinol Metab. 2022;107(Suppl_1):S36-S46. doi: 10.1210/clinem/dgac168 pmid: 36346685
5. Baeg J, Choi HS, Kim C, Kim H, Jang SY. Update on the surgical management of Graves’ orbitopathy. Front Endocrinol (Lausanne). 2023;13:1080204. doi: 10.3389/fendo.2022.1080204 pmid: 36824601
6. Parrilla C, Mele DA, Gelli S, Zelano L, Bussu F, Rigante M, et al. Multidisciplinary approach to orbital decompression. A review. Acta Otorhinolaryngol Ital. 2021;41(Suppl. 1):S90-S101. doi: 10.14639/0392-100X-suppl.1-41-2021-09 pmid: 34060524
7. Braun TL, Bhadkamkar MA, Jubbal KT, Weber AC, Marx DP. Orbital Decompression for Thyroid Eye Disease. Semin Plast Surg. 2017;31(1):40-45. doi: 10.1055/s-0037-1598192 pmid: 28255288
8. Bagheri A, Shahraki K, Tavakoli M. Optic Disc Deformation and Orbital Bone Erosion Secondary to a Huge Neglected Orbital Cavernous Hemangioma. J Craniofac Surg. 2018;29(8):e790-e792. doi: 10.1097/SCS.0000000000004777 pmid: 30277940
9. Burch HB, Perros P, Bednarczuk T, Cooper DS, Dolman PJ, Leung AM, et al. Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association. Eur Thyroid J. 2022;11(6):e220189. doi: 10.1530/ETJ-22-0189 pmid: 36479875
10. Costan VV, Ciocan-Pendefunda CC, Ciofu ML, Boisteanu O, Timofte DV, Gheorghe L, et al. Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy. Graefes Arch Clin Exp Ophthalmol. 2020;258(10):2313-2320. doi: 10.1007/s00417-020-04807-4 pmid: 32588167
11. Leong SC, Karkos PD, Macewen CJ, White PS. A systematic review of outcomes following surgical decompression for dysthyroid orbitopathy. Laryngoscope. 2009;119(6):1106-15. doi: 10.1002/lary.20213 pmid: 19358198
12. Cubuk MO, Konuk O, Unal M. Orbital decompression surgery for the treatment of Graves’ ophthalmopathy: comparison of different techniques and long-term results. Int J Ophthalmol. 2018;11(8):1363-1370. doi: 10.18240/ijo.2018.08.18 pmid: 30140642
13. Elangovan N, Bangalore Muniyappa Shanmugham D. Binocular vision parameters and body mass index. Med Hypothesis Discov Innov Optom. 2023; 4(1): 17-24. doi: 10.51329/mehdioptometry169
14. Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, et al; European Group on Graves’ Orbitopathy (EUGOGO). The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J. 2016;5(1):9-26. doi: 10.1159/000443828 pmid: 27099835
15. Rajabi MT, Tabary M, Baharnoori S, Salabati M, Mahmoudzadeh R, Hosseinzadeh F, et al. Orbital anatomical parameters affecting outcome of deep lateral orbital wall decompression. Eur J Ophthalmol. 2021;31(4):2069-2075. doi: 10.1177/1120672120941433 pmid: 32627588
16. Victores AJ, Takashima M. Thyroid Eye Disease: Optic Neuropathy and Orbital Decompression. Int Ophthalmol Clin. 2016;56(1):69-79. doi: 10.1097/IIO.0000000000000101 pmid: 26626933
17. Saeed P, Tavakoli Rad S, Bisschop PHLT. Dysthyroid Optic Neuropathy. Ophthalmic Plast Reconstr Surg. 2018;34(4S Suppl 1):S60-S67. doi: 10.1097/IOP.0000000000001146 pmid: 29927882
18. Pelewicz M, Rymuza J, Pelewicz K, Mi?kiewicz P. Dysthyroid Optic Neuropathy: Treatment with Additional Intravenous Methylprednisolone Pulses after the Basic Schedule Is Associated with Stabilization or Further Improvement of Clinical Outcome. J Clin Med. 2022;11(8):2068. doi: 10.3390/jcm11082068 pmid: 35456161
19. Tagami M, Honda S, Azumi A. Insights into Current Management Strategies for Dysthyroid Optic Neuropathy: A Review. Clin Ophthalmol. 2022;16:841-850. doi: 10.2147/OPTH.S284609 pmid: 35330749
20. Fichter N, Guthoff RF, Schittkowski MP. Orbital decompression in thyroid eye disease. ISRN Ophthalmol. 2012;2012:739236. doi: 10.5402/2012/739236 pmid: 24558591
21. Verity DH, Rose GE. Acute thyroid eye disease (TED): principles of medical and surgical management. Eye (Lond). 2013;27(3):308-19. doi: 10.1038/eye.2012.284 pmid: 23412559
22. Sellari-Franceschini S, Rocchi R, Marinò M, Bajraktari A, Mazzi B, Fiacchini G, et al. Rehabilitative orbital decompression for Graves’ orbitopathy: results of a randomized clinical trial. J Endocrinol Invest. 2018;41(9):1037-1042. doi: 10.1007/s40618-018-0847-7 pmid: 29450866
23. Ye Y, Hu F, Ji Y, Wang R, Zhu K, Kong Q. The outcomes of endoscopic orbital decompression combined with fat decompression for thyroid-associated ophthalmopathy. BMC Ophthalmol. 2023;23(1):217. doi: 10.1186/s12886-023-02957-7 pmid: 37193956
24. Hain?ro?ie R, Ioni?? I, Pietro?anu C, Pi?uru S, Hain?ro?ie M, Zainea V. Transnasal endoscopic orbital decompression. Rom J Ophthalmol. 2017;61(3):192-195. doi: 10.22336/rjo.2017.35 pmid: 29450397
25. O’Malley MR, Meyer DR. Transconjunctival fat removal combined with conservative medial wall/floor orbital decompression for Graves orbitopathy. Ophthalmic Plast Reconstr Surg. 2009;25(3):206-10. doi: 10.1097/IOP.0b013e3181a424cc pmid: 19454932
26. DeParis SW, Tian J, Rajaii F. Practice Patterns in Orbital Decompression Surgery Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members. Ophthalmol Ther. 2019;8(4):541-548. doi: 10.1007/s40123-019-00206-z pmid: 31422554
27. Jernfors M, Välimäki MJ, Setälä K, Malmberg H, Laitinen K, Pitkäranta A. Efficacy and safety of orbital decompression in treatment of thyroid-associated ophthalmopathy: long-term follow-up of 78 patients. Clin Endocrinol (Oxf). 2007;67(1):101-7. doi: 10.1111/j.1365-2265.2007.02845.x pmid: 17466006
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