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Payal Patel, Kira Lauren Segal, Benjamin M Levine, Gary J Lelli; Lower Lid Height Following Transconjunctival Approach for Orbital Decompression. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4105.
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Orbital decompression via the transconjunctival approach is a procedure commonly performed in the treatment of patients with Thyroid Eye Disease (TED). Advantages of this approach include improved cosmesis achieved by avoiding cutaneous incision and less risk of diplopia. The transconjunctival approach includes recession of the lower eyelid retractors. Although eyelid retraction is a feared complication of orbital fat decompression, transection of the lower eyelid retractors may in fact elevate the lower lids, minimizing or eliminating scleral show as secondary gain. The purpose of this study is to evaluate the change in lower eyelid position following transconjunctival approach for orbital decompression.
Retrospective case review of all patients who underwent orbital decompression via transconjunctival approach by the Ophthalmology department at NewYork-Presbyterian Hospital/Weill Cornell Medical College between the 2008-2013 academic years. These patients were followed post-operatively for at least six months. Primary end points assessed in this study included pre- and post- operative scleral show, margin reflex distance 2 (MRD2), lower lid to brow height (LL-B), ratio of MRD2 to LL-B, and Hertel measurement.
A total of 8 patients underwent 14 orbital decompressions via the transconjunctival approach. All patients had thyroid eye disease as the underlying diagnosis. Seventy-five percent (n=6) of cases were bilateral. Sixty-four percent (n=9) of patients had decrease in ratio of MRD2/lower lid to brow height, indicating elevation of the lower lid height post-operatively. One patient had an increase in ratio MRD2/LL-B, and this later required a lid tightening procedure. There was substantial decrease in scleral show in this cohort. All patients had decrease in Hertel measurement, indicating improved proptosis.
Orbital fat decompression via the transconjunctival approach is a safe and effective procedure to treat proptosis in patients with TED. The lower eyelid may be elevated post-operatively, with potential to eliminate scleral show inferiorly. The presumed mechanism is retractor recession during the surgical approach to the fat pockets.
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