Surgical management of thyroid orbitopathy

Area of Science:

• Ophthalmology
• Neurosurgery
• Endocrinology

Background:

• Thyroid orbitopathy often causes proptosis, leading to cosmetic concerns and potential vision impairment.
• Orbital surgical decompression aims to alleviate these symptoms by reducing intraorbital pressure.

Purpose of the Study:

• To evaluate the effectiveness of orbital surgical decompression in patients with thyroid orbitopathy and varying degrees of proptosis.
• To compare outcomes of fat removal alone versus combined fat and bone decompression.

Main Methods:

• Retrospective analysis of 56 patients (115 orbits) undergoing orbital decompression for Graves' orbitopathy.
• Surgical techniques included fat removal, bone decompression (coronal, trans-palpebral, trans-nasal), or a combination.
• Endoscopic trans-nasal approach with fat removal became the preferred method for medial wall decompression.

Main Results:

• Mean proptosis reduction was 3.40 mm with fat removal and 5.40 mm with combined procedures.
• Combined surgery minimized fat removal, preventing enophthalmos and reducing bone decompression extent.
• New-onset primary-gaze diplopia occurred in 38% of patients; many required subsequent eyelid surgery.

Conclusions:

• Orbital decompression effectively reduces proptosis, exposure keratopathy, and apex congestion, improving cosmesis.
• Endoscopic decompression with fat removal allows precise, less aggressive bone decompression.
• Individualized surgical tailoring is crucial, with potential need for secondary procedures for optimal cosmetic results.