Three-wall orbital decompression superiority to 2-wall orbital decompression in thyroid-associated ophthalmopathy.

Area of Science:

• Ophthalmology
• Neurosurgery
• Endocrinology

Background:

• Graves' disease often leads to dysthyroid optic neuropathy and disfigurement due to proptosis.
• Orbital decompression surgery is a key treatment for managing these complications.
• Evaluating different surgical approaches is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the efficacy of 2-wall versus 3-wall orbital decompression in patients with Graves' disease.
• To assess the degree of exophthalmos reduction and surgical safety of each approach.

Main Methods:

• A consecutive series of patients with Graves' disease underwent either 2-wall (endoscopic transnasal medial, transantral inferior) or 3-wall (2-wall plus transcutaneous lateral) orbital decompression.
• Exophthalmos was measured using the Hertel exophthalmometer preoperatively and at multiple postoperative intervals (24 hours, 1, 3, and 9 months).

Main Results:

• The 3-wall decompression resulted in a significantly greater mean reduction in exophthalmos (7.75 mm) compared to the 2-wall approach (4.38 mm) at 3 months.
• Visual acuity was maintained or improved in all patients.
• Ocular motility disturbances and new-onset diplopia were infrequent and comparable between the two groups.

Conclusions:

• The 3-wall orbital decompression provides superior proptosis reduction in Graves' disease patients compared to the 2-wall technique.
• Both surgical approaches are deemed safe, with similar complication rates.
• The 3-wall approach is recommended for enhanced aesthetic and functional outcomes.