Original article
Endoscopic Medial Orbital Fat Decompression for Proptosis in Type 1 Graves Orbitopathy

https://doi.org/10.1016/j.ajo.2014.10.029Get rights and content

Purpose

To describe the surgical technique for endoscopic medial orbital fat decompression in type 1 (lipogenic) Graves orbitopathy and report outcomes.

Design

Retrospective interventional case review.

Methods

We reviewed 108 patients (206 orbits) with inactive, type 1 Graves orbitopathy without diplopia, who underwent endoscopic medial orbital fat decompression solely for proptosis reduction. Following endoscopic transethmoid medial orbital wall decompression, extraconal and intraconal orbital fat was removed with a low-suction cutting instrument. All patients were followed up for at least 12 months. Surgical time, preoperative and postoperative Hertel exophthalmometry, incidence of postoperative diplopia within 30-degree visual field in the primary gaze, and other complications were analyzed.

Results

The mean surgical time was 97.7 ± 16.7 minutes (67–136 minutes). The mean follow-up was 16.0 ± 4.2 months (12–24 months). Preoperative and postoperative proptosis values at final review were 21.1 ± 2.3 mm (17–26 mm) and 13.0 ± 0.9 mm (12–15 mm), respectively (P < .001). Median reduction in proptosis was 8.0 mm with mean of 8.2 ± 1.8 mm (4–11 mm). Symmetry to within 2 mm was achieved in 106 of 108 patients (98.1%). Twenty-five of 108 patients (23.1%) had diplopia within 30-degree visual field of the gaze, and 23 of these had complete resolution within 3 months, while the remaining 2 patients required squint surgery.

Conclusions

Endoscopic medial orbital fat decompression may be an effective technique for proptosis in selected patients with type 1 Graves orbitopathy and is associated with a low rate of surgically induced diplopia.

Section snippets

Patients and Methods

This study was performed at the Eye Hospital of Wenzhou Medical University, Jinhua Center Hospital, Lishui Center Hospital, Quzhou People's Hospital and Li Huili Hospital, the Second People's Hospital of Zhengzhou, Xingtai Eye Hospital, and Mianyang Eye Hospital from October 1, 2006 to May 30, 2013, in compliance with the guidelines of the Declaration of Helsinki. Included patients had type 1 Graves orbitopathy (Figure 1, Top left) as evidenced by preoperative orbital high-resolution computed

Results

From October 1, 2006 to May 30, 2013, 116 Asian patients with type 1 Graves orbitopathy underwent endoscopic medial orbital decompression for proptosis (Figure 1, Left). Three patients with unstable thyroid function were excluded, in addition to 3 patients who failed to attend follow-up beyond 6 months postoperatively and 2 patients who did not have Hertel exophthalmometry and diplopia recorded at follow-up review. A total of 108 patients (74 female, 34 male) (216 orbits) were included, with a

Discussion

We have described a new orbital decompression technique using an endoscopic medial orbital approach in patients with type 1 Graves orbitopathy. We found a mean proptosis reduction of 8.2 ± 1.8 mm, and at final review 1.9% patients (2/108) had surgically induced diplopia requiring strabismus surgery. Our findings suggest that endoscopic medial orbital decompression may be an effective technique for proptosis reduction in type 1 Graves orbitopathy with a relatively low risk of diplopia.

Endoscopic

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