Analysis of endoscopic orbital decompression with and without navigation for thyroid eye disease

Our objective was to assess the outcomes of endoscopic orbital decompression for Graves' ophthalmopathy and to compare outcomes in cases where the StealthStation™ S8 surgical navigation was utilized versus those without navigation assistance.

We reviewed endoscopic orbital decompressions carried out for Graves' ophthalmopathy in the Royal Victoria Eye & Ear Hospital between 2004 and 2024. Outcomes assessed were pre- and postoperative measurements of best corrected visual acuity (BCVA), exophthalmometry, intraocular pressure (IOP), color vision, and optical coherence tomography findings. Results were evaluated by repeated measures analysis of variance. An anonymized survey with 5-point Likert scale questions was also performed to assess surgeons' perspective on image guided navigation (IGS).

A total of 67 orbits in 37 patients underwent endoscopic orbital decompression for Graves' ophthalmopathy in the time period, 30 orbits with IGS versus 37 without navigation (non-IGS). Overall, BCVA, proptosis, IOP, and color vision all were significantly improved at 3-month follow-up (p < 0.05). There was no significant difference in nerve fiber layer or ganglion cell layer thickness at 3-month (p > 0.05). BCVA was significantly better at 1- and 3-month post-op (p < 0.05) in the IGS cohort. Ten patients required squint surgery. Survey results indicated surgeon's found IGS made orbital surgery easier and safer to perform.

Endoscopic orbital decompression offers an effective, safe, and minimally invasive treatment for Graves' ophthalmopathy. There is a trend toward continued improvement in outcomes over the course of 3 months post-operatively with visual outcomes being significantly better in cases where surgical navigation was used.