Surgical effects of various orbital decompression methods in thyroid-associated orbitopathy: computed...

Area of Science:

• Ophthalmology
• Plastic and reconstructive surgery
• Endocrinology

Background:

• Thyroid-associated orbitopathy (TAO) frequently causes exophthalmos, impacting patient quality of life.
• Surgical decompression is a common treatment for severe exophthalmos in TAO.
• Evaluating the efficacy of different surgical decompression techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

• To assess the surgical effects of orbital fat decompression and bony decompression of individual orbital walls in TAO patients.
• To correlate surgical decompression volumes with exophthalmos reduction using computed tomography (CT).
• To determine the predictability, efficiency, and contribution of each surgical approach to overall exophthalmos reduction.

Main Methods:

• Retrospective analysis of 27 TAO patients (48 orbits) with exophthalmos undergoing combined orbital wall and fatty decompression.
• Intraoperative measurement of resected orbital fat volume.
• Postoperative CT to estimate decompression volume of deep lateral, medial, and inferior orbital walls.
• Correlation analysis between Hertel exophthalmos readings and decompression volumes.

Main Results:

• Orbital fat and deep lateral wall decompression showed a higher correlation with exophthalmos reduction (predictability).
• Surgical efficiency was highest for the deep lateral wall (2.704 mm/cm³), followed by the medial wall, orbital fat, and inferior wall.
• Fatty decompression contributed most to exophthalmos reduction, followed by deep lateral wall decompression.

Conclusions:

• Orbital fat and deep lateral orbital wall decompression are predictable and contributory targets for reducing exophthalmos in TAO.
• These findings guide surgical planning for improved outcomes in TAO patients.
• Targeting orbital fat and the deep lateral wall maximizes exophthalmos reduction efficacy.