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Paul Petrakos, Benjamin M Levine, Ashutosh Kacker, Aaron Pearlman, Gary J Lelli; Surgical treatment of proptosis secondary to Thyroid Eye Disease without a cutaneous incision. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):570.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the improvement of proptosis secondary to Thyroid Eye Disease in patients treated surgically without the use of a cutaneous incision.
A retrospective study of 24 eyes of 13 patients who were surgically treated for proptosis secondary to Thyroid Eye Disease (TED) without the use of a cutaneous incision. Patients included in the study underwent either (1) bony decompression (endoscopic medial orbital wall and orbital floor decompression with removal of bone with or without fat), or (2) orbital fat decompression. Pre-operative and post-operative Hertel measurements, as well as patient satisfaction, were documented to assess surgical outcomes.
<br /> The average pre-operative Hertel measurement for all eyes was 24mm (SD 3.75), 25mm (SD 4.96) for the bone decompression group (n=8), and 23mm (SD 1.69) for the fat decompression group (n=8). The average post-operative Hertel measurement for all eyes was 19.6mm (SD 1.08), 19.8mm (SD 1.39) for the bone decompression group (n=8), and 19.4mm (SD 0.69) for the fat decompression group (n=8). The mean post-operative improvement in Hertel measurement for all patients regardless of surgical modality was 4.6mm (SD 3.03) with a two-tailed p value <0.0001. For the eyes that underwent bone decompression improvement was 5.3mm (SD 3.65), while fat decompression was 3.9mm (SD 2.28). The difference in proptosis between the two different surgical groups was not statistically significant (p=0.373). Hertel pre and post-operative measurements were not recorded for 8 patients. Subjectively all patients (100%) reported satisfaction with their post-operative outcomes. No post-operative infections or inadequate decompression were seen in any cases. One patient required subsequent strabismus surgery for diplopia, but had a history of strabismus and patching as a child.
Orbital decompression with removal of bone or orbital fat decompression without the use of a cutaneous incision is an efficacious and safe modality for the treatment of proptosis in TED patients. There was a statistically significant improvement in proptosis for all patients treated surgically. The difference between the two surgical groups was not statistically significant. Employing this modality in aesthetically-minded patients who are concerned over the potential for a cutaneous scar may be advantageous.
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