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Jia Quan Chaung, Raghuraj Hegde, Shantha Amrith, Inez Wong, Siew Shuen Chao, Gangadhara Sundar; Outcomes of Surgical Management of Thyroid Eye Disease: A Single-Centre Retrospective Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):572.
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To study the outcomes of surgical management of thyroid eye disease (TED) in a South East Asian Population
Retrospective single-centre case series of all TED patients requiring surgery from Nov 2002 to August 2014 by 2 Oculoplastic surgeons. Data recorded included demographic data, pre-operative and post-operative visual acuity and exophthalmometry for orbital decompression; ocular alignments, revision surgeries for both strabismus and eyelid retraction.
Of the 336 TED patients seen, 57 patients underwent surgery, 24 male (42.1%) and 33 female (57.9%). Ethnicity: Chinese (73.7%), Malay (14.0%), Indian (5.3%), Others (7.0%). Mean age was 44.2 years (Range 2-81). Surgical indications: Eyelid retraction (52.6%), proptosis (45.7%), cosmesis (33.3%), Exposure Keratopathy (10.5%), Compressive optic neuropathy (8.8%). Surgical procedures included orbital decompression (54.4%), eyelid surgery (52.6%) and strabismus surgery (24.6%). 60 orbits of 31 patients were decompressed: 2-wall (36.7%), pure fat (23.3%) 3-wall (21.7%), 1-wall (18.3%). Medial wall access - retrocaruncular (61.1%) or endonasal (38.9%). Most 2-wall decompressions involved balanced lateral and medial walls (72.7%). The mean reduction in exophthalmometry was 4.5mm (Range -2 - 17) with an improvement of at least one Snellen line in 62.9% of patients. Rate of induced strabismus was 3.2%. Strabismus surgery was performed on 23 eyes of 14 patients of which 1 required surgical revision. Medial rectus was most frequently recessed (34.6%). Diplopia was resolved in 85.7%. Most eyelid surgeries involved the upper lid (55.1%) and Muller’s muscle resection (69.7%). Mean reduction of MRD by 1.5mm. Satisfaction with appearance was achieved in 89.7% while 20.7% of eyelid surgeries required revision. Other eyelid procedures performed included entropion surgery, permanent tarsorrhaphy, epiblephron repair, ptosis repair and blepharoplasty.
Surgery for TED is not uncommon in our South-East Asian population. Orbital decompression was efficacious in reducing proptosis and improving visual acuity. Complications observed included diplopia and paresthesia. Strabismus and eyelid surgery were used to effectively reduce diplopia and lid retraction respectively. However, they may require revision surgeries to achieve adequate correction.
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