[Bony orbital decompression in thyroid eye disease]. / Kostnaya dekompressiya orbity pri endokrinnoi oftal'mopatii.

This article summarizes the results of research on the morphological and functional features of different types of orbital bone decompression in thyroid eye disease (TED) and presents an analysis of surgical anatomy of the lateral orbital wall in the context of performing deep lateral bone decompression of the orbit was carried out. The study includes an analysis of the results of orbital bone decompression with resection of the greater wing of the sphenoid bone using ultrasound osteodestructor in comparison with osteodestruction using a high-speed drill, description of transethmoidal orbital decompression with endonasal access both as a single method of surgical treatment of TED and in combination with lateral bone decompression of the orbit, including the advantages and disadvantages of the method, and presents a morphological description of the pathological changes in the medial orbital wall bone fragments obtained during endonasal transethmoidal orbital decompression in patients with TED.

[Potential of bony regrowth after deep lateral orbital decompression]. / O vozmozhnosti kostnogo rosta posle glubokoi dekompressii lateral'noi stenki orbity.

The article describes a very rare case of bony regrowth after deep lateral orbital decompression for thyroid eye disease. Bony regrowth was observed in the area of the resected «trigone¼ of the greater wing of the sphenoid bone and in the area of the exposed dura mater. This case demonstrates that bony regrowth can be a possible cause of exophthalmos (proptosis) recurrence after orbital decompression in thyroid eye disease without clinical or laboratory evidence of reactivation of the disease.

[Comparative electron microscopy study of the bone surfaces relief after ultrasonic and mechanical high-speed bone removal in orbital decompression]. / Sravnitel'noe élektronno-mikroskopicheskoe issledovanie rel'efa kostnykh poverkhnostei posle ul'trazvukovoi i vysokoskorostnoi mekhanicheskoi osteodestruktsii pri dekompressii orbity.

PURPOSE: To compare the results of scanning electron microscopy studies of the surface of bone fragments of orbital lateral wall formed by mechanical and ultrasonic bone removal devices. MATERIAL AND METHODS: The surfaces of 7 bone fragments have been investigated after bony orbital decompression in patients with thyroid eye disease (TED). Electron microscopy of the bone relief was performed after exposure to an ultrasonic surgical system or a high-speed drill. RESULTS: Electron microscopy revealed that relief of the bony surface within a compact substance after application of an ultrasonic aspirator had parallel grooves of the same type up to 100 µm in depth and 80-100 µm wide, with relatively smooth edges. In the area of impact on spongy substance the bone surface became more amorphous, rougher due to the exposure of cellular structures at different depths. High-speed drill used in the area of compact substance left monotonous, almost flat relief with individual compact conglomerates of bone 'dust'. Removal of thinned fragments of the compact substance of the specimen led to appearance of the cellular structure typical for a spongy substance. CONCLUSION: Data on features of the relief of the edges of bone 'window' obtained for the first time, as well as specifics of working in conditions of limited surgical access allowed the conclusion that modern ultrasonic bone aspiration is promising for deep lateral wall decompression and some other orbital interventions.

[Phasing and continuity of the treatment of thyroid eye disease in patients with Graves' disease].

 According to modern concepts, thyroid eye disease (TED) is an independent progressive autoimmune disease of the organ of vision, closely associated with the autoimmune pathology of the thyroid gland (TG), (ICD code - H06.2, proptosis in case of impaired thyroid function E05.0). TED treatment is a long step-by-step process, including immunosuppressive therapy, radiation therapy of the orbits and surgical treatment.TED is a multidisciplinary problem. A patient with thyrotoxicosis clinic and TED symptoms will be taken to an endocrinological clinic for normalization of thyroid hormones and treatment of thyrotoxicosis complications. At the same time, under the supervision of an ophthalmologist, TED diagnostics and treatment will be carried out. Teamwork is of utmost importance because the effectiveness of TED treatment will depend on the speed of achieving a stable euthyroid state, the accuracy of determining the TED activity and severity, and the presence of complications requiring surgical treatment.There are two main phases in the TED development. In the first phase of active inflammation, an increase in the symptoms of TED occurs, then a plateau phase follows, when the symptoms of activity persist but do not progress, then the symptoms regress and the process becomes inactive, while visual disturbances and cosmetic defects may persist. Determining the TED activity is very important from a clinical point of view, because the choice of treatment and tactics of patient management depend on the inflammation activity.We describe a clinical case of phasing treatment of TED complicated by optic neuropathy and movement disorders in a patient with Graves' disease, resistant to immunosuppressive therapy with glucocorticoids and requiring deep lateral bony orbital decompression.