[Clinical efficacy of endoscopic transnasal orbital decompression combined with optic nerve decompression for Graves...

Objective: To evaluate the efficacy of endoscopic transnasal orbital decompression combined with optic nerve decompression in the treatment of Graves ophthalmopathy (GO) and to analyze its influencing factors. Methods: A retrospective case-series study was conducted. Clinical data were collected from 56 patients (79 eyes) with moderate-to-severe GO who underwent endoscopic transnasal orbital decompression combined with optic nerve decompression in the Department of Otorhinolaryngology Head and Neck Surgery at the First Affiliated Hospital of Sun Yat-sen University between January 2019 and September 2024. There were 30 males and 26 females, with a mean age of (52.00±9.88) years (x¯±s). Patient age, clinical activity score (CAS), and duration of ocular symptoms were recorded. Visual acuity, exophthalmos, and intraocular pressure (IOP) were documented preoperatively and postoperatively. Patients were divided into the following groups: by disease duration (<12 months, 12-18 months, ≥18 months); by preoperative visual acuity (<0.01 and ≥0.01); by preoperative intravenous glucocorticoid pulse therapy (treated and untreated); and by preoperative CAS (≥3 and<3). The improvement in visual acuity, exophthalmos, and IOP was compared among groups. Linear mixed-effects models were employed to analyze the effects of various factors on surgical outcomes. Statistical analysis was performed using SPSS 26.0 software. Results: Visual acuity improved from 0.20 (0.36) (median (IQR)) preoperatively to 0.50 (0.50) postoperatively; exophthalmos decreased from 20.50 (4.50) mm to 19.00 (5.50) mm; and IOP decreased from 20.70 (7.30) mm Hg to 19.00 (6.00) mm Hg. All changes were statistically significant (Z value was -6.27, -5.95, and -2.63, respectively; all P<0.01). Patients with disease duration <12 months demonstrated significantly greater improvement in visual acuity compared to other groups (H=9.51, P=0.009). Linear mixed-effects model analysis revealed an estimated improvement in visual acuity of 0.16 for the <12-month group compared to the ≥18-month group; however, this difference did not reach statistical significance (P=0.086). Gender, age, CAS, preoperative visual acuity, and steroid therapy had no significant effect on visual acuity improvement (all P>0.05). Exophthalmos reduction was significantly greater in the preoperative visual acuity <0.01 group than in the ≥0.01 group (Z=-2.09, P=0.036). Lower preoperative visual acuity was an independent predictor of greater exophthalmos improvement (F=6.46, P=0.016), with an estimated value of 2.15 (P=0.016). CAS and preoperative steroid use demonstrated trends toward association with exophthalmos reduction (P=0.188 and P=0.131, respectively), though neither reached statistical significance, whereas, gender, age, and disease duration had no statistically significant effects (all P>0.05). No significant correlation was found between IOP improvement and any of the evaluated factors (all P>0.05). Conclusions: Endoscopic transnasal orbital decompression combined with optic nerve decompression is an effective treatment for GO. Disease duration and preoperative visual acuity emerge as significant predictors of surgical outcomes, with optimal results observed in patients with disease duration<12 months and more severely compromised preoperative visual acuity (<0.01).