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Katharina A. Ponto, Julia Karbach, George J. Kahaly, Norbert Pfeiffer, Bilal Al-Nawas, Susanne Pitz; Piezosurgery - A Novel Tool for Bony Decompression in Graves' Orbitopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5111.
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Complications of conventional orbital decompression in Graves' orbitopathy (GO) include hypesthesia of the infraorbital nerve, periorbital swelling, entropion, sinusitis, and hypoglobus. We hypothesized that being equally effective, these side effects are minimized by the use of ultrasound bone scalpels (mectronTM piezosurgery, Cologne, Germany). To the best of our knowledge, this pilot study is the first to evaluate this technique as a tool for decompression in GO.
Piezosurgery was performed in 27 orbits of 15 patients as a two or three wall decompression via an inferior fornix approach. Pre- and postoperative ophthalmic assessment included 3D CT and face scan. At the time of this preliminary evaluation, 9 patients had completed a 3 months follow-up.
Reasons for surgery were cosmetic rehabilitation (21 orbits), optic neuropathy (n=4) and corneal ulceration (n=2).Piezosurgery achieved a micrometric cut (precise action to limit tissue damage), a selective cut (mineralized tissues), and a clear surgical site (by the cavitation effect created by an irrigation/cooling solution and oscillating tip). The 3 D CT showed that the cuts were highly precise. The 3 D face scan confirmed a distinct reduction of the periorbital swelling in all patients. The mean reduction of proptosis directly after and 3 months after surgery was 2.4±0.4 mm and 3.3±0.5 mm, respectively. Optic nerve compression and corneal ulceration were successfully cured. Infraorbital hypesthesia was present in one patient out of nine after 3 months. One patient developed a subtle hypoglobus and an entropion. No case of post-operative sinusitis was noted.
Piezosurgery permits a high visibility and precise cuttings. It is highly effective in proptosis reduction, in cases of exposure keratopathy, and in decompressing the optic nerve. Regardless the specificity for mineralized tissues, there were complications indicating that damage to adjacent soft tissue may not be overall prevented. Prospective randomized trials have to be performed to substantially compare efficacy and safety of piezosurgery and of conventional orbital decompression.
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