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S. Gudsoorkar, C. Lane, M. Keskar; Orbital Decompression Can Reduce the Incidence of Diplopia in Graves’ Orbitopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5269.
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Orbital decompression in Graves’ Orbitopathy is usually performed for disfiguring exophthalmos and compressive optic neuropathy not controlled by other modalities of treatment. The majority of patients can be adequately controlled with one, two or three wall decompression. Only extreme cases require four wall decompression.
A retrospective study analyzing the preoperative clinical parameters, surgical approaches and techniques, outcome of orbital decompression procedures performed in patients with Graves’ Orbitopathy.
28 orbital decompressions were retrospectively analyzed based on the data collected from the thyroid clinic notes with particular stress on preoperative symptoms, surgical approach, post operative symptoms, reduction in proptosis, post operative complications and scar satisfaction.
28 orbits of 17 patients were decompressed with 19 orbits having a transconjunctival approach. The average number of preoperative symptoms was 4 and reduced to 2.17 postoperatively. The incidence of diplopia reduced from 58.8% (10 patients) to 35.3% (6 patients) with none of the patients developing iatrogenic diplopia postoperatively. The mean reduction in proptosis was 2.8mm. 3 patients (17.6%) had chronic sinus problems and 9 patients had hypaesthesia 2 months postoperatively.DEMOGRAPHICS28 Decompressions in 17 patients16 - female, 13- SmokersAll Caucasian42% aged 51-60yrsINDICATIONS10/28 for dysthyroid optic neuropathy18/28 inactive disease for proptosisAPPROACHTransconjuctival -19, Translid-7, Coronal-2.Lateral wall only - 4Two wall -11Three wall - 13Medial strut preserved in all the patientsINCIDENCE OF DIPLOPIAPre-op 10/17Post-op 6/17Induced diplopia - 1/17(5.8%)Reduction in diplopia - 5/17(29%)MEAN PROPTOSIS REDUCTION- 2.7mm
Transconjunctival orbital decompression is a very effective procedure with good functional outcome and minimal morbidity for the patients. There was a significant decrease in proptosis and diplopia and high degree of patient satisfaction with regard to the symptoms and cosmesis. The preservation of the orbital strut and anterior 1cm of the orbital floor reduced the incidence of hypoglobus, iatrogenic diplopia and entropion.
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