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Oscillopsia After Isolated Lateral Wall Decompression Versus Balanced or 3-Wall Decompression.

Laura Porrúa-Tubío1,2, Andrea Sales-Sanz3,4, Pablo de-Arriba-Palomero1,3

  • 1Ophthalmology Department, Ramón y Cajal Universitary Hospital, IRYCIS, Madrid.

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|May 30, 2020
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Summary

Isolated lateral wall decompression for orbital decompression surgery leads to higher rates of oscillopsia compared to balanced or 3-wall techniques. Diplopia outcomes remained similar between surgical approaches.

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Area of Science:

  • Ophthalmology
  • Plastic Surgery
  • Neurosurgery

Background:

  • Orbital decompression surgery is performed for various conditions, including thyroid eye disease.
  • Postoperative complications can affect visual function and quality of life.
  • Masticatory oscillopsia, a rare complication, involves visual disturbance during chewing.

Purpose of the Study:

  • To compare the incidence of masticatory oscillopsia after isolated lateral wall decompression versus balanced or 3-wall orbital decompression.
  • To evaluate the impact of decompression technique on diplopia.

Main Methods:

  • Retrospective study of 131 patients undergoing orbital decompression (2008-2018).
  • Patients categorized into isolated lateral wall decompression ('lateral') or balanced/3-wall decompression ('lateral plus').
  • Oscillopsia and diplopia (Paridaens grading) were assessed postoperatively.

Main Results:

  • Seven of 131 patients reported oscillopsia (p=0.001).
  • Higher incidence of oscillopsia in the 'lateral' group (5 patients) compared to the 'lateral plus' group (2 patients).
  • No significant difference in new-onset or worsening diplopia between groups (p=1).

Conclusions:

  • Isolated lateral wall decompression is associated with a significantly higher risk of oscillopsia.
  • Balanced or 3-wall decompression may mitigate oscillopsia risk.
  • Temporal muscle contraction transmission to the orbit is hypothesized as the cause, with intact orbital walls potentially acting as dampeners.