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Quantitative Assessment of Orbital Decompression Surgery Using Photogrammetric Stereoimaging.

Fabiola Murta1, Jonathan N Hyer1, Anjana Haridas1

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Summary

Quantitative stereoimaging reveals that bony orbital decompression for thyroid eye disease (TED) significantly reduces periorbital volume and proptosis. Eyelid volume changes after decompression influence subsequent reconstructive surgery decisions.

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Area of Science:

  • Ophthalmology
  • Plastic Surgery
  • Medical Imaging

Background:

  • Thyroid eye disease (TED) can cause proptosis and eyelid abnormalities.
  • Bony orbital decompression is a surgical option to address these issues.
  • Accurate volumetric assessment of periorbital changes is crucial for treatment planning.

Purpose of the Study:

  • To quantify periorbital volume changes after bony orbital decompression in TED patients using stereoimaging.
  • To compare these volumetric changes with Hertel exophthalmometry measurements.
  • To independently assess upper and lower eyelid tissue volume changes.

Main Methods:

  • Prospective study of adult patients with inactive TED undergoing bony orbital decompression.
  • Quantitative photogrammetric stereoimaging (VECTRA M3 system) performed preoperatively and postoperatively (≥3 months).
  • Calculation of periorbital, upper, and lower eyelid volumes; proptosis measured by Hertel exophthalmometry; correlation analysis performed.

Main Results:

  • Bony orbital decompression led to significant reductions in periorbital volume (average 1.74-4.52 ml) and proptosis (average 3.6-9 mm) depending on decompression extent.
  • A strong positive correlation was found between periorbital volume changes and Hertel exophthalmometry reduction (r = 0.713, p < 0.0001).
  • Lower eyelid volume reduction did not significantly increase beyond two-wall decompression.

Conclusions:

  • Graded bony orbital decompression effectively reduces both proptosis and eyelid tissue volumes in TED.
  • Observed eyelid volume changes are important considerations for planning subsequent reconstructive eyelid surgery.
  • These findings support the established sequence of thyroid periocular rehabilitation: decompression, strabismus surgery, then eyelid surgery.