Augmented endoscopic orbital apex decompression in dysthyroid optic neuropathy

Area of Science:

• Ophthalmology
• Neurosurgery
• Endoscopic Surgery

Background:

• Dysthyroid optic neuropathy (DON) can cause vision loss in patients with thyroid eye disease.
• Corticosteroid treatment is often the first line of therapy for DON.
• Some patients with DON are refractory to pulsed corticosteroids, requiring alternative treatments.

Purpose of the Study:

• To describe a modified endoscopic orbital decompression technique.
• To evaluate the efficacy of this technique in patients with dysthyroid optic neuropathy unresponsive to corticosteroids.

Main Methods:

• A retrospective, interventional case series of 17 patients with DON.
• Patients were refractory to pulse corticosteroids.
• The technique involved endoscopic transethmoidal medial orbital wall decompression (ETMOWD) combined with removal of the posteromedial orbital floor and the orbital process of the palatine bone (OPPB).

Main Results:

• All 17 eyes showed statistically significant improvement in visual acuity.
• Color vision improved in 14 out of 16 eyes, and afferent pupillary defects resolved in all cases.
• Proptosis reduction averaged 2.7 mm, and no new-onset diplopia occurred.

Conclusions:

• Combined removal of the posterior medial floor (including OPPB) with ETMOWD is a viable surgical option.
• This modified technique offers effective decompression for the orbital apex in refractory DON cases.