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NAYELI ALCARAZ LARES, ALBERTO ABDALA, OSIRIS OLVERA-MORALES, JOSE LUIS TOVILLA CANALES; Orbital Decompression in Thyroid Eye Disease, A 5 year review in a reference center in Mexico City. Invest. Ophthalmol. Vis. Sci. 2016;57(12):709.
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© ARVO (1962-2015); The Authors (2016-present)
Thyroid eye disease (TED) is a form of autoimmune orbital inflammation which during its active inflammatory phase, leads to infiltration of muscles, lacrimal glands and orbital fat by lymphocytes and glycosaminoglycans. Decompression can be utilized to treat these cases and different approaches can be chosen such as a bone or fat removal. We performed a retrospective study to describe the initial presenting characteristics, surgical approaches and outcomes during our 5 year experience.
A total of 19 patients were selected, for a total of 38 orbits. Gender 12 females and 7 males. A retrospective review of all patients undergoing orbital decompression for TED associated criteria between 2010 and 2015. Clinical outcome measures included were demographic data, Hertel exophthalmometry pre and post op, surgical technique elected and preoperative thyroid status. Patients who did not meet the criteria were excluded. T student test was applied to all variables.
Median age for males was 45 and 51 years for females with no statistical significant difference between genders. Technique chosen was bony decompression in 15 cases (78.9%) and fat decompression in 4 cases (21.1%). In bony decompression the most common option was inferior plus medial walls in 68.4% of cases, followed by 3 walls (lateral, medial and inferior) in 10.5%. The most common indication for surgery was disthyroid optic neuropathy (52.6%), followed by cosmetic (31.6%) and intractable IOP (15.8%). 57.9% of patients received steroid treatment prior to surgery and 94.7% received steroids post op. Thyroid status prior to surgery showed hyperthyroidism in 17 cases (89.5%). Hertel exophthalmometry post op showed a medium decrease of 3mm in both eyes with a bony decompression and a medium of 4.5mm with a fat decompression.
Our findings correlate to previous published data except the result that fat decompression provides a greater decrease in post exophthalmometry. Our study is limited by several factors particularly its retrospective nature and small cohort of patients which is inherent due to the rare nature of this procedure. We believe more prospective studies are needed to verify our findings and to provide clear guidelines with which to choose the most appropriate conduct.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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