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Follow-up of transnasal orbital decompression in severe Graves' ophthalmopathy
O Michel1, N Oberländer, P Neugebauer
1Department of Otorhinolaryngology, University of Cologne, Cologne, Germany. University-Eye Clinic, Department of Neuroophthalmology, University of Cologne, Cologne, Germany. michel@unikoeln.de
Objective:
To evaluate the safety and efficacy of transnasal orbital decompression for severe Graves' ophthalmopathy.
Design:
Retrospective noncomparative case series with extended clinical follow-up.
Participants:
Seventy-eight consecutive subjects who were operated on for compressive optic neuropathy with loss of visual acuity or visual field defects after failure of medical and radiation therapy.
Intervention:
Strictly transnasal, endoscopic-controlled bilateral decompression of the medial and inferomedial wall of the orbit.
Main Outcome Measurements:
Preoperative and postoperative examination, including vision, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and notification of complications, intranasal signs of inflammation, and subjects' assessment of the procedure.
Results:
One hundred forty-five endonasal decompressions were performed on 78 subjects (63 women, 15 men, 52.2 +/- 10.3 years) during a 10-year period. Sixty five patients were bilaterally operated on; 15 required only unilateral decompression. Four of 78 needed repeat surgery. Visual acuity increased from a preoperative average of 0.50 +/- 0.27 (range, 0.01-1.25) to 0.75 +/- 0.21 (range, 0.01-1.25) postoperatively. An average reduction of proptosis of 3.94 +/- 2.73 mm (range, -1.0-11.0 mm) was achieved with a mean preoperative Hertel measurement of 22.19 +/- 3.13 mm (range, 15-34 mm). Ocular motility was corrected by recession of the medial rectus muscle in 58 of 78 cases. Twenty-six of these 58 cases were simultaneously operated on in the same surgical session immediately after the transnasal decompression, and the others after a period of 2 to 3 months.
Conclusions:
The transnasal orbital decompression procedure improved vision, decreased proptosis in a range comparable to more invasive techniques, and had favorable cosmetic results without additional disfiguration by scars. Morbidity was far less than with other approaches. Postdecompression strabismus was successfully managed by recession of both medial orbital muscles in the same surgical session.