Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis
DOI:
https://doi.org/10.48560/rspo.32537Keywords:
Decompression, Surgical, Graves Ophthalmopathy, Orbit/surgery, Tomography, X-Ray ComputedAbstract
INTRODUCTION: Orbital decompression surgery has been widely used in thyroid eye disease (TED). It is performed in the active stage, in sight-threatening cases of dysthyroid compressive optic neuropathy (DON), or severe corneal exposure unresponsive to steroids, and also during the quiescent phase to address proptosis. The purpose of this study is to analyze both clinical and imagiological outcomes of patients with TED who underwent orbital decompression.METHODS: A retrospective analysis of patients undergoing orbital decompression in Centro Hospitalar Universitário de Lisboa Central and Hospital Cuf Descobertas, between 2018 and 2021, was performed. Demographic and clinical data were collected. The procedures included lateral, inferior-medial, balanced (lateral and medial) and three-wall decompressions. Main clinical outcomes included best corrected visual acuity (BCVA), proptosis reduction and complications. A group of patients underwent orbital computed tomography (CT) scanning before and after surgery, and differences in globe displacement in the horizontal, vertical and anteroposterior planes were measured for each type of surgery.
RESULTS: Forty-six orbits from 28 patients (18 females and 10 males) underwent decompression surgery. Mean age at time of surgery was 49.43 ± 11.63 years old. Orbital decompression was performed during the inactive phase in 19 patients (67.4%) and was required to treat sight-threatening active TED in 9 patients (32.6%). Lateral, inferior-medial, balanced and three-wall decompression were carried out in 12 (26.1%), 8 (17.4%), 14 (30.4%) and 12 (26.1%) orbits, respectively. From baseline, statistically significant improvements were observed after surgery in logMAR BCVA (p<0.05) and proptosis (p<0.001). Larger proptosis reduction occurred in three-wall decompression, followed by balanced decompression (p<0.001). New-onset strabismus occurred in 3 of the 28 patients (10.7%): 1 endoscopic inferior-medial decompression, 1 three-wall decompression with an endoscopic approach to the inferior and medial walls and 1 transorbital three-wall decompression. All the 3 cases presented DON non-reversible with high dose intravenous steroids.
CONCLUSION: Orbital decompression is an effective procedure to address proptosis in TED, being also an important resource in cases of DON unresponsive to systemic steroids. The reduction in proptosis is associated with the number of orbital walls addressed. An individualized approach is crucial during surgical planning in TED cases.
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