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Deep lateral orbital decompression for Graves orbitopathy: a systematic review.
Antonio Augusto V Cruz1, Bruna S N Equiterio2, Barbara S A Cunha2
1Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil. aavecruz.fmrp@gmail.com.
International Ophthalmology
|January 31, 2021
Summary
Deep lateral orbital decompression (DLD) effectively reduces proptosis with a low rate of new diplopia. Surgical technique does not significantly impact outcomes, but further studies are needed to compare complication rates.
Area of Science:
- Ophthalmology
- Neurosurgery
- Surgical Techniques
Background:
- Orbital decompression is a surgical procedure to alleviate increased intraorbital pressure.
- Deep lateral orbital decompression (DLD) is one technique used for this purpose.
- Understanding the efficacy and safety of DLD is crucial for managing orbital conditions.
Purpose of the Study:
- To systematically review the existing literature on deep lateral orbital decompression (DLD).
- To analyze surgical techniques, outcomes, and complications associated with DLD.
- To evaluate the effectiveness of DLD in reducing exophthalmos and horizontal eye position.
Main Methods:
- Comprehensive literature search of MEDLINE, Lilac, Scopus, and EMBASE databases.
- Inclusion of articles in English, Spanish, French, and German using keywords 'orbital decompression' and 'lateral wall'.
- Data extraction included patient numbers, surgical approaches (ab-interno, ab-externo, rim-off), exophthalmometry changes, and complications.
Main Results:
- 131 out of 204 initially retrieved publications were included in the review.
- Analysis of 4559 procedures across 2705 patients revealed mean Hertel changes ranging from 2.5 to 4.5 mm, independent of technique.
- The rate of new-onset diplopia was low (0-8.6%), with reported complications including dry eye, oscillopsia, and rare instances of amaurosis and subdural hematoma.
Conclusions:
- Deep lateral orbital decompression (DLD) is associated with a low incidence of new-onset diplopia, representing a significant benefit.
- The surgical approach (ab-interno, ab-externo, rim-off) does not appear to influence the degree of decompression achieved.
- Further prospective studies are recommended to directly compare complication rates among the primary surgical techniques used in DLD.
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