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1.
Korean J Ophthalmol ; 33(5): 436-445, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612654

RESUMO

PURPOSE: We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography. METHODS: Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups-a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan-and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated. RESULTS: At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01). CONCLUSIONS: The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Órbita/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Oftalmopatia de Graves/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/diagnóstico por imagem , Órbita/diagnóstico por imagem , Estudos Prospectivos , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
2.
Strabismus ; 27(3): 143-148, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31407938

RESUMO

Background: Recession and resection of rectus muscles for correction of strabismus in Thyroid Eye Disease (TED) is relatively unpopular as it is assumed to enhance the restriction of ocular ductions. Therefore, the purpose of this study was to compare ductions of recession only and recess/resect procedures. Methods: We retrospectively reviewed the charts of 119 patients who underwent strabismus surgery for TED from 1991 to 2015, of which 102 were included in the present study. Forty-six interventions were performed on horizontal, 56 on vertical rectus muscles; comprising 41 recess/resect surgeries for horizontal deviations, and 7 in patients with vertical strabismus. Ocular ductions and alignment were evaluated preoperatively and at 3 and 12 months postoperatively. Results: Both recessions as well as recess/resect procedures resulted in improved abduction and elevation, respectively. At the exam 3 months postoperatively, median abduction for the recession only group and the recess/resect group were 27.5° and 35°, respectively. The similar figures for elevation were 25° and 10°, respectively. Neither were statistically significant. No restricted adduction or depression was seen in the recess/resect surgeries groups with lateral or superior rectus resection. None of the patients showed unusual postoperative inflammation or conjunctival scarring. Conclusion: In this retrospective analysis, we found an equal effect on ocular ductions in patients with TED when comparing recess/resect eye muscle surgery to recess only procedures. In TED patients with large horizontal angle deviations and abduction deficit, medial rectus recession and lateral rectus resection surgery can be considered. Muscle resections in TED do not seem to have a clinically relevant risk to increase the restriction of ocular ductions but rather improve ductions in the restricted directions of gaze.


Assuntos
Movimentos Oculares/fisiologia , Oftalmopatia de Graves/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Resultado do Tratamento
3.
Acta Otolaryngol ; 139(10): 876-880, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31460819

RESUMO

Background: Rhinosinusitis may cause serious complications, such as secondary orbital infections, resulting in expansion and erosion of process through the orbital wall. Aims: The aim is to evaluate long-term outcome of ESS in patients suffered from endocrine ophthalmopathy and orbital complications of rhinosinusitis. Material and methods: Thirteen patients with loss of vision, endocrine ophthalmopathy and orbital complication of rhinosinusitis were treated by ESS. Preoperative and postoperative vision was rated by best-corrected visual acuity (BCVA) testing. Nine (69%) have been reinvestigated after 6 years by ophthalmology examination and 10-point scale for assessment of clinical symptoms. Results: The mean BCVA significantly increased after surgery comparing to results before surgery (0.84, 0.62; respectively) (p = .007). The mean values of 10-point scale for subjective assessment of symptoms 6 years after surgery were: headache 2.11, sinonasal pressure 1.72, subjective estimation of vision quality on the affected eye was 7.33 and olfaction 7.66. None of the patients developed impairment of vision loss in postoperative period. Conclusions: Long-term outcome of ESS showed decreased symptoms in patients who had endocrine ophthalmopathy and orbital complication of rhinosinusitis. Significance: ESS has numerous advantages for patients with orbital complication and vision loss comparing to conservative treatment and should be considered even in abscess absence.


Assuntos
Endoscopia , Rinite/complicações , Rinite/cirurgia , Sinusite/complicações , Sinusite/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Oftalmopatia de Graves/etiologia , Oftalmopatia de Graves/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/etiologia , Doenças Orbitárias/cirurgia , Estudos Retrospectivos , Avaliação de Sintomas , Resultado do Tratamento
4.
Ophthalmic Plast Reconstr Surg ; 35(6): 590-593, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162299

RESUMO

PURPOSE: Orbital decompression is an established surgical treatment option for a range of orbital conditions. Traditionally, Ear, Nose and Throat surgeons have adopted the endoscopic route while ophthalmologists operate via an external approach. The authors report the outcomes of endonasal decompression performed by oculoplastic surgeons experienced in endonasal techniques. METHODS: This was a retrospective case series of patients who underwent endoscopic orbital decompression for proptosis secondary to thyroid eye disease across 2 hospital sites between January 2011 and July 2018. Inclusion criteria were patients who had endoscopic decompression for proptosis in inactive thyroid eye disease or active disease without dysthyroid optic neuropathy. Information collected includes patient demographics, diagnosis, surgical details, preoperative and postoperative clinical findings (including, visual acuity, color vision, exophthalmometry readings, palpebral aperture, intraocular pressure, ocular motility, diplopia, and visual field), complications, and further treatment. RESULTS: There were 70 cases of endoscopic decompression. The majority of patients had endoscopic medial and posterior medial wall/floor decompression (44.3%; 31/70 cases). Visual acuity remained stable in 98.6% (69/70). There was an average reduction in proptosis of 3.5 ± 1.2 mm (standard deviation [SD]) in the endoscopic medial wall only group, 3.9 ± 0.9 mm (SD) in endoscopic medial wall and posterior medial portion of the floor group, and 7.6 ± 2.1 mm (SD) in the 3-wall decompression group. Motility improved in 11.4% (8/70) and worsened in 2.9% (2/70). There were no significant intraoperative or postoperative complications associated with endoscopic surgery. CONCLUSIONS: Oculoplastic surgeons experienced in endonasal techniques can perform endoscopic orbital decompression with outcomes comparable to the literature.The authors report the outcomes of a series of endonasal orbital decompression carried out by oculoplastic surgeons.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Exoftalmia/cirurgia , Oftalmopatia de Graves/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Pol Merkur Lekarski ; 46(275): 224-228, 2019 May 27.
Artigo em Polonês | MEDLINE | ID: mdl-31152536

RESUMO

Graves' orbitopathy (GO) is an extrathyroidal manifestation of Graves' disease (GD). The majority of patients has mild form of the disease, with no need of additional treatment. A few percent of patients can have a severe or very severe course of disease. In severe forms of GO there might occur considerable exophthalmos complicated in some cases with corneal ulceration or pressure on optic nerve leading to neuropathy (DON, dysthyroid optic neuropathy). In therapy of severe forms of GO different types of treatment are used depending on diagnosis and activity of disease. The pharmacological (among the others very high doses of intravenous methylprednisolone) and surgery treatment (orbit decompression) are used. The orbital decompression is a procedure performed in order to decrease the intraorbital pressure by removing part of its bony borders in cases with excessive mass in orbit. For decades many external approaches have been used. With the progress of the endoscopic techniques the endoscopic orbit decompression has become the first line treatment. The lack of facial incisions is connected with many benefits for patients. In our article endoscopic decompression technique in GO was described, as well as available medical literature concerning this technique and its outcomes was performed.


Assuntos
Descompressão Cirúrgica , Exoftalmia , Oftalmopatia de Graves , Endoscopia , Exoftalmia/cirurgia , Oftalmopatia de Graves/cirurgia , Humanos , Órbita
6.
PLoS One ; 14(6): e0218701, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31233522

RESUMO

PURPOSE: Orbital decompression surgery is performed in patients with Graves' orbitopathy to treat dysthyroid optical neuropathy (DON) and reduce disfiguring proptosis. The intended proptosis reduction can deviate from the postoperative result and changes of motility with consecutive diplopia can occur. We performed a retrospective study to identify anatomical factors in computed tomography (CT), which influence the surgical effect and postoperative ocular motility and diplopia. METHODS: Pre- and postoperative CT-scans of 125 eyes of 68 patients, who mainly underwent a balanced orbital decompression for disfiguring proptosis (≥18mm Hertel Index), have been analyzed. Proptosis, ductions, misalignment and diplopia were assessed before and after surgery. Medial and lateral orbital wall length, conus angle, depth of ethmoidal sinus, orbital surface, length of medial and orbital defect, depth of tissue prolapse and horizontal muscle diameters were analyzed in CT scans before and after surgery. With linear regression and multivariate analyses these parameters have been correlated with postoperative proptosis, abduction deficit, deviation and binocular single vision (BSV). RESULTS: Proptosis could be reduced by 5.3±2mm. Patients with <5mm proptosis reduction had significantly less often new onset of diplopia compared to patients with >5mm reduction (13% vs. 56%, p = 0.02). Multiple linear regression showed a significant correlation between tissue prolapse and depth of the ethmoidal sinus as well as age (p<0.001, r = 0.71). Proptosis reduction could not be predicted by tissue prolapse, defect length or depth of ethmoidal sinus. The abduction deficit correlated significantly with tissue prolapse and orbital surface area (p<0.001, r = 0.37) but not with the horizontal muscle diameter. CONCLUSION: We were able to show that orbital morphology influences the outcome of balanced orbital decompression surgery in terms of proptosis reduction and motility. However, the rather low coefficients of correlation show that the surgical outcome cannot be predicted with simple CT measurements, although risk factors for postoperative abduction deficit could be found. Therefore, preoperative planning should consider especially the orbital surface area and depth of ethmoidal sinus. Patients should be informed about the higher risk of diplopia with higher proptosis reduction.


Assuntos
Exoftalmia/cirurgia , Oftalmopatia de Graves/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Diplopia/cirurgia , Exoftalmia/diagnóstico por imagem , Movimentos Oculares , Feminino , Oftalmopatia de Graves/diagnóstico por imagem , Oftalmopatia de Graves/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/métodos , Órbita/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Graefes Arch Clin Exp Ophthalmol ; 257(6): 1303-1308, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30941511

RESUMO

PURPOSE: Current outcome measures do not adequately address the esthetic aspect of the surgical outcome of anterior blepharotomy for Graves' ophthalmopathy. This study aims to highlight the role of tarsal platform show (TPS) in optimizing the esthetic outcome of graded full-thickness anterior blepharotomy for dysthyroid upper eyelid retraction in an ethnic Chinese population. METHODS: The records of patients with Graves' ophthalmopathy who underwent anterior blepharotomy for upper eyelid retraction over a period of 30 months were retrospectively reviewed. RESULTS: Fifty-five patients (77 eyelids) with upper eyelid retraction underwent anterior blepharotomy. A statistically significant decrease in marginal reflex distance (MRD1) and lagophthalmos and significant increase in TPS following anterior blepharotomy was observed. A significantly higher proportion of patients who underwent unilateral anterior blepharotomy had TPS asymmetry post-operatively as compared to the bilateral group (p < 0.001). Using logistic regression, the study found that for every 1-mm change in MRD1, there was approximately a 1.045-mm change in TPS. The mean percentage increase in TPS observed in our study was 303.1 ± 191% due to the low pre-operative TPS seen in Asian patients. CONCLUSIONS: To achieve the most ideal surgical outcome in graded full-thickness anterior blepharotomy, the surgeon will need to consider not only eyelid height but also the subsequent TPS change. The surgeon needs to be mindful of the relationship between MRD1 change and TPS change to optimize esthetic outcome as well as symmetry. Special considerations need to be taken in unilateral cases as well as patients with low pre-operative TPS.


Assuntos
Blefaroplastia/métodos , Doenças Palpebrais/cirurgia , Oftalmopatia de Graves/cirurgia , Estética , Doenças Palpebrais/etiologia , Pálpebras/cirurgia , Feminino , Oftalmopatia de Graves/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
10.
Orbit ; 38(5): 376-382, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30628512

RESUMO

Purpose: Thermal injury to the optic nerve is a potential complication of bony decompression of the orbital apex. An animal model was used to compare and contrast temperature change while removing orbital bone with ultrasonic and conventional drills. Methods: Two devices, Sonopet ultrasonic bone curette and TPS CORE Micro drill, were used to remove bone from six unpreserved exenterated porcine orbits at fixed distances from the optic canal while temperature was recorded. Increasing irrigation flow rate and decreasing saline temperature with the ultrasonic bone curette were also investigated. Results: The mean change in temperature at the optic canal using the ultrasonic bone curette with 18 ml/min 24°C irrigation was +7.2 ± 3.3°C (range 3.3-12.7°C) at 60 s, and using the rotational drill was +1.7 ± 1.3°C (range 0.1-3.3°C), representing a statistically significant increase above baseline for both drills (p < 0.01 for each). The difference in temperature change between drills was statistically significant (p < 0.01). When irrigation fluid was changed from room temperature saline (24°C), rate 18 ml/min to chilled (10°C) irrigation saline, rate 40 ml/min, the magnitude of the mean temperature increase was reduced by 3.1°C, p < 0.05. Conclusions: In this orbital decompression model, both ultrasonic and rotational drills induced a rise in temperature. This increase was significantly greater with the ultrasonic bone curette, measuring up to 13.7°C. Clinicians should be aware of the potential for temperature spikes when decompressing the orbital apex. Increasing irrigation flow rate and using chilled saline may mitigate increases in temperature.


Assuntos
Temperatura Corporal/fisiologia , Osso e Ossos/fisiologia , Descompressão Cirúrgica/instrumentação , Órbita/cirurgia , Osteotomia/instrumentação , Terapia por Ultrassom/métodos , Animais , Oftalmopatia de Graves/cirurgia , Modelos Animais , Disco Óptico/fisiologia , Osteotomia/métodos , Suínos , Irrigação Terapêutica
11.
Medicine (Baltimore) ; 98(3): e14162, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653159

RESUMO

In this study, we try to explore the effect of orbital decompression treatment on severe dysthyroid optic neuropathy.We retrospectively collected demographic and clinical characteristics of thyroid eye disease patients who performed orbital decompression. Then we analyzed the change of best-corrected visual acuity and exophthalmometry after surgery and the correlations among clinical parameters.A total of 22 cases (30 eyes) were included in the study. After orbital decompression, visual acuities improved in 16 eyes, declined in 8 eyes, and had no change in 5 eyes. Best-corrected visual acuity was significantly improved (0.1 vs 0.4, P = .039) and exophthalmometry was significantly declined (22.0 mm vs 16.5 mm, P = .001) after orbital decompression. Better postoperative best-corrected visual acuity was significantly correlated with better preoperative best-corrected visual acuity (r = 0.718, P < .05), and with normal optic disc (r = 0.568, P < .05), but not with age, exophthalmometry, keratopathy, and clinical activity score.These results showed that orbital decompression is a useful approach to manage dysthyroid optic neuropathy. The optimal time for surgery should be chosen based on clinical parameters, such as visual acuity and degree of crowding of orbital apex.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/complicações , Síndromes de Compressão Nervosa/cirurgia , Doenças do Nervo Óptico/cirurgia , Órbita/cirurgia , Adulto , Feminino , Oftalmopatia de Graves/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Doenças do Nervo Óptico/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
12.
Klin Monbl Augenheilkd ; 236(1): 17-24, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30690696

RESUMO

BACKGROUND: Graves' orbitopathy is the most common extrathyroidal manifestation of Graves' disease. In the burnt out fibrotic phase exophthalmos, diplopia and lid retraction may remain, which can require multiple rehabilitative surgical interventions. Orbital decompression is an established surgical procedure for the treatment of exophthalmos in Graves' orbitopathy. The aim of the study was to evaluate the efficacy and side effects of the deep lateral orbital wall decompression including the orbital rim. METHODS: In this retrospective, non-comparative case series, all patients with Graves' orbitopathy, who underwent lateral orbital wall decompression at the Eye Clinic of the University of Göttingen between 2008 and 2015, were analysed in terms of exophthalmos reduction, diplopia (Gorman score) and complications. The surgical technique involved the removal of the lateral orbital wall including the orbital rim combined with additional orbital fat resection via swinging eyelid approach. RESULTS: 127 patients who underwent 195 orbital decompressions were included. Mean exophthalmos reduction was 4.0 ± 1.2 mm (range 1.5 - 7.5 mm). Preoperatively, 47 patients/77 orbits (37.0/39.5%) presented without diplopia. Postoperatively, 3 patients/3 orbits (6.4/3.9%) showed new-onset diplopia (2.4% of all patients, 1.5% of all orbits). Diplopia in primary gaze was noted in one of the 3 patients (0.8% of all patients, 2.1% of patients without preoperative diplopia), and inconstant diplopia was seen in the other 2 patients. Postoperative improvement of diplopia was noted in 19 patients/19 orbits (15.0% of all patients, 23.8% of patients with preoperative diplopia/9.7% of all 195 interventions), and 16.1% of cases with preexisting diplopia. No severe complications were seen, except for one case of postoperative bleeding, which was successfully managed surgically without any functional deficits. A visible scar formation was noted in 6 cases (3.1%), temporal hollowing in 3 cases (1.5%), oscillopsia when chewing in 3 cases (1.5%) and a de-insertion of the lateral canthal region in 2 cases (1%). CONCLUSIONS: Deep lateral orbital wall decompression, including the orbital rim, is an effective surgical technique to reduce exophthalmos in patients with Graves' orbitopathy with a low risk of functional and aesthetic complications.


Assuntos
Descompressão Cirúrgica , Exoftalmia , Oftalmopatia de Graves , Oftalmopatia de Graves/cirurgia , Humanos , Órbita , Estudos Retrospectivos , Resultado do Tratamento
13.
J Plast Reconstr Aesthet Surg ; 72(6): 973-981, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30679116

RESUMO

PURPOSE: To compare injections of hyaluronic acid (HA) and autologous fat (AF) for the treatment of unsightly temporal hollowing after lateral orbital wall decompression in thyroid eye disease. METHODS: In this nonblinded prospective comparative interventional study, patients received injections of HA in the right temple and AF in the left temple. Additional injections were given when needed at follow-up after 6, 12, 18, and 24 months. Follow-up included an interview; clinical examination with an evaluation of symmetry, contour, and skin surface; and ultrasound measurements. From photographs, the temporal hollowing was graded 1-3. The main endpoints were grading of temporal hollowing and temporal soft tissue thickness. RESULTS: Seventeen patients were treated bilaterally and 12 unilaterally (five received HA and seven AF). Injection(s) of HA and AF administered at each site were a median (range) of 1 (1-4) and 2 (1-5), respectively. The total combined volume of HA injected per site was 0.9 (0.2-2.0) ml and that of AF was 3.1 (0.5-9.6) ml. At the final examination, a statistically significant difference in mean (SD) grading scores of temporal hollowing due to HA (1.18 (0.26)) compared to those of AF (1.85 (0.44)) was observed (p < 0.001). Six months after administering an injection of HA, the temporal soft tissue thickness was 2.35 (0.24) cm compared to 2.19 (0.28) cm obtained with an injection of AF (p < 0.001). By using a linear mixed-effect model and adjusting for baseline values, age, sex, and refill, the difference in favor of HA persisted at all later follow-ups. Increased fibrosis of the subcutaneous tissue developed at 5/24 sites that received AF. CONCLUSION: Injection of HA is superior to that of AF for treating temporal hollowing after lateral orbital wall decompression.


Assuntos
Tecido Adiposo/transplante , Descompressão Cirúrgica/efeitos adversos , Oftalmopatia de Graves/cirurgia , Ácido Hialurônico , Órbita/cirurgia , Complicações Pós-Operatórias , Descompressão Cirúrgica/métodos , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/efeitos adversos , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Resultado do Tratamento , Viscossuplementos/administração & dosagem , Viscossuplementos/efeitos adversos
14.
Eye (Lond) ; 33(2): 206-211, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30390053

RESUMO

Orbital decompression surgery and medical therapy for thyroid eye disease (TED) have evolved over the past 150 years and afforded the opportunity to restore pre-disease appearance and visual function. This manuscript explores the past 150 years of surgical innovation for the treatment of TED. The "Age of Surgical Heroism" spans the time from 1888 to 1979 during which the pioneers of orbital decompression developed lateral orbitotomy, transcranial decompression, paranasal sinus decompression, and transantral decompression despite an incomplete understanding of the pathophysiology of both TED and a limited ability to non-invasively assess their patients. The "Age of Surgical Refinement" dawned with the development of computed tomography and represents the years 1979-2000. During this time, the "swinging eyelid" approach for two- and three-wall decompressions was introduced, a combined orbital-extradural four wall decompression procedure was developed, fat decompression was explored, and endoscopic decompression techniques were advanced. At the beginning of the 21st century, our understanding of the orbital pathophysiology of TED evolved significantly. Clinicians recognized the age-related phenotype of TED based largely on the relative contribution of extraocular muscle enlargement vs. orbital fat expansion. The "Modern Age" of Customized Orbital Decompression features both "medical decompression" during the active phase of TED and, in the stable phase, customized surgical plans incorporating individual patients' anatomy, orbital pathology, and surgical goals that collectively maximize therapeutic benefit while minimizing therapeutic morbidity.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Doenças do Nervo Óptico/cirurgia , Órbita/cirurgia , Endoscopia , Oftalmopatia de Graves/fisiopatologia , Humanos , Doenças do Nervo Óptico/fisiopatologia
15.
Orbit ; 38(3): 184-186, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30335556

RESUMO

Purpose: To compare efficacy and safety of mechanical drill and piezoelectric technology in the prevention of infraorbital nerve hypoaesthesia during orbital floor decompression. Methods: Single-centre, non-randomized prospective, interventional case series. We enrolled 24 patients who underwent 3-wall orbital decompression. A total of 13 patients underwent floor decompression using 5-mm diamond dusted Piezoelectric tip (Synthes GmbH, Oberdorf, Germany), whereas 11 patients underwent conventional mechanical decompression of the floor using Stryker Core handpiece with 5-mm diamond dusted tip (Stryker, USA) and a Kerrison's bone ronguer. All surgeries were performed by a single surgeon (MNN) using standard surgical technique. The infraorbital nerve hypoesthesia was measured pre-operatively, and post-operatively on day 1, at 1 week, 6 weeks, 3 months, and final follow-up by an independent observer. Hypoaesthesia was graded on a simple numerical scale: 0 defined as "normal", 1 defined as "minimally reduced", 2 defined as "grossly reduced but perceptible", and 3 defined as "total loss". Results: The average follow-up after surgery was 16 months (range 13-48 months). The average score in the mechanical drilling group at day 1, week 6, week 12 and final follow-up was 1.9, 1.2, 0.7, and 0.6, respectively (p < 0.001). For the Piezo group, the average scores were 0.3, 0.2, 0.1, and 0.1, respectively. No procedure related complications were noted, and the average surgical time for floor decompression was comparable (p > 0.5). Conclusions: Piezoelectric technology is effective in orbital floor removal by minimizing infraorbital nerve hypoaesthesia.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/cirurgia , Hipestesia/prevenção & controle , Órbita/cirurgia , Procedimentos Ortopédicos/instrumentação , Piezocirurgia/métodos , Doenças do Nervo Trigêmeo/prevenção & controle , Adulto , Feminino , Seguimentos , Humanos , Masculino , Fenômenos Mecânicos , Pessoa de Meia-Idade , Órbita/inervação , Estudos Prospectivos , Resultado do Tratamento
16.
Acta Ophthalmol ; 97(1): 74-79, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30284412

RESUMO

PURPOSE: To examine the outcome of the use of donor sclera as spacer material in complicated cases of strabismus surgery. METHODS: A retrospective cohort study on patients with complicated thyroid-associated ophthalmopathy (TAO) (n = 42) or congenital strabismus (n = 75). Patients underwent strabismus surgery during 1994-2014. The surgical results were evaluated in terms of the reduction in the angle of deviation, the need for re-operation, complications and patient satisfaction. RESULTS: The majority of the TAO patients underwent surgery for vertical strabismus (n = 25). The vertical angle of deviation in the primary position was significantly reduced from a median of 23 prism dioptres (PD) to 2 PD (n = 35, p < 0.001). The horizontal angle of deviation in primary position for TAO patients with esotropia was significantly reduced, from a median of 35 PD to 2 PD (n = 17, p < 0.001). The majority of the congenital cases had horizontal strabismus (esotropia = 29, exotropia = 27). The angle of deviation in esotropia was reduced from a median of 29 PD to 8 PD (n = 36, p < 0.001) and in exotropia from 30 PD to 10 PD (n = 34, p < 0.001). Most of the patients were satisfied with the outcome of surgery, and only 12% required re-operation within 2 years. CONCLUSION: This is the first clinical study on the use of donor sclera as spacer material in complicated cases of strabismus surgery. The surgical results were good in terms of the reduction in the angle of deviation, the need for re-operation, complications and patient satisfaction, supporting the use of donor sclera for strabismus surgery.


Assuntos
Oftalmopatia de Graves/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Satisfação do Paciente , Complicações Pós-Operatórias , Esclera/transplante , Estrabismo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Movimentos Oculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Reoperação , Estudos Retrospectivos , Estrabismo/congênito , Resultado do Tratamento , Adulto Jovem
17.
Orbit ; 38(3): 173-179, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30142011

RESUMO

Purpose: To measure alterations in orbital blood flow parameters using color Doppler imaging (CDI) before and after orbital decompression in patients with moderate to severe thyroid eye disease (TED). Methods: Resistance index (RI) and maximum and minimum velocity of ophthalmic artery (OA), superior ophthalmic vein (SOV), and central retinal artery (CRA) of 24 eyes (14 patients) with TED were measured before and at least 3 months after cosmetic orbital decompression procedure (single or double walls) using CDI. Complete eye examination was performed to define the severity (EUGOGO classification) and activity (clinical activity score) of TED. Results: Median OA (p = 0.003) and CRA (p = 0.001) resistance indices were significantly reduced postoperatively. Significant differences were found in maximum (p = 0.001) and minimum (p = 0.014) velocity of SOV before and after surgery. While a significant decrease in exophthalmometry was observed after the orbital decompression (p = 0.031), intraocular pressure changes were not significant (p = 0.182). Conclusion: Orbital decompression procedure led to a significant reduction of RI in both CRA and OA in patients with TED.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/fisiopatologia , Oftalmopatia de Graves/cirurgia , Artéria Oftálmica/fisiologia , Órbita/irrigação sanguínea , Artéria Retiniana/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Feminino , Oftalmopatia de Graves/diagnóstico por imagem , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/diagnóstico por imagem , Órbita/diagnóstico por imagem , Estudos Prospectivos , Fluxo Sanguíneo Regional/fisiologia , Artéria Retiniana/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Veias/diagnóstico por imagem , Veias/fisiologia
18.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(3S): S49-S52, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30170970

RESUMO

AIMS: To report visual acuity outcomes and potential complications in patients undergoing endoscopic transnasal orbital decompression in the setting of acutely deteriorating sight secondary to dysthyroid optic neuropathy (DON) unresponsive to corticosteroid therapy. No previous reports describe vision outcomes in this specific patient population undergoing urgent endoscopic decompression. MATERIAL AND METHODS: Retrospective case review at a tertiary-care academic hospital. Four patients with DON were identified that underwent urgent endoscopic orbital decompression for acutely deteriorating vision. Three patients underwent a later decompression of the other orbit, yielding seven decompressions in total for acutely deteriorating vision. Operative technique entailed inferior and medial wall decompressions. The posterior limit of medial wall decompression was within the sphenoid, just anterior to the annulus of Zinn to fully decompress the optic nerve. Primary outcome was visual acuity. RESULTS: In all seven decompressions, visual acuity improved substantially. In 5/7 eyes, preoperative vision was severely impaired at 20/150 or worse. Two eyes had mild and moderate impairment at 20/50 and 20/100. Post-operatively, the moderately and severely impaired eyes improved to 20/60 or better. No complications were encountered. CONCLUSION: Transnasal endoscopic orbital decompression is a safe, effective treatment for acutely worsening visual loss from DON. All cases demonstrated significant objective improvement in visual acuity. Given the need for later contralateral decompression in 3 patients, consideration should be given to performing bilateral orbital decompressions at the time of surgery.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Doenças do Nervo Óptico/cirurgia , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento de Emergência/métodos , Feminino , Oftalmopatia de Graves/complicações , Humanos , Pessoa de Meia-Idade , Doenças do Nervo Óptico/etiologia , Órbita/cirurgia , Estudos Retrospectivos , Osso Esfenoide/cirurgia
19.
Eur J Ophthalmol ; 29(4): NP13-NP15, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30270655

RESUMO

PURPOSE: To report a case of inadvertent inferior oblique extirpation during orbital decompression, its management, and postoperative result. METHODS: A 38-year-old female with thyroid eye disease underwent cosmetic right orbital decompression during whichinferior oblique extirpation was noticed. RESULT: The muscle was repaired on the same session (illustrated in the article) with no postoperative diplopia at 3-month follow-up. CONCLUSION: Inferior oblique injury should be considered among the uncommon yet important complications of orbital decompression. It can be easily found and repaired in the same session as demonstrated in this case report.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Traumatismos Oculares/etiologia , Oftalmopatia de Graves/cirurgia , Complicações Intraoperatórias , Músculos Oculomotores/lesões , Adulto , Exoftalmia/cirurgia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Órbita , Período Pós-Operatório , Estudos Retrospectivos
20.
Orbit ; 38(2): 95-102, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29482415

RESUMO

AIM: To describe differences in the deep lateral orbital wall (specifically, trigone) between Chinese, Malay, Indian and Caucasian subjects Methods: Single-centre retrospective Computed Tomogram (CT)-based study; 20 subjects of each ethnicity were used from existing databases, matched for gender, average age and laterality. Subjects below 16 years of age were excluded. DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) and OsiriX version 7.5 (Pixmeo., Switzerland) were used to measure deep lateral wall length, thickness and volume, as well as orbital depth and statistical analyses performed using Statistical Package for Social Sciences version 21 (IBM, USA). RESULTS: In each group, there were 12 males (60%) and average age was not significantly different (p = 0.682-0.987). Using Chinese subjects as a reference, in Chinese, Malay, Indian and Caucasian subjects, mean trigone thickness was 13.68, 14.02, 11.60 (p < 0.001) and 13.80 mm, curved total wall length 45.23, 42.29 (p = 0.048), 41.91 (p = 0.020) and 45.00 mm, curved trigone length 23.03, 22.61, 17.19 (p = 0.011) and 18.76 mm (p = 0.030) and trigone volume 3120.97, 3221.01, 1613.66 (p < 0.001), 2498.46 mm3 (p = 0.059) respectively. Similarly, perpendicular orbital depth was 27.54, 24.97, 22.12 (p = 0.001) and 25.93 mm and diagonal orbital depth was 34.19, 33.27, 29.48 (p = 0.01) and 34.63 mm respectively. CONCLUSIONS: Indian and, to a lesser extent, Caucasian subjects have smaller trigones compared to their Chinese and Malay counterparts. Indian subjects also have shallower orbits and due care should be taken during decompression surgery.


Assuntos
Descompressão Cirúrgica , Grupos Étnicos , Órbita/anatomia & histologia , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Oftalmopatia de Graves/cirurgia , Humanos , Índia/epidemiologia , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Órbita/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
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