Personalized orbital decompression surgery for thyroid-associated orbitopathy: a comprehensive retrospective analysis...

This study aimed to comprehensively evaluate the efficacy and safety of personalized multimodal orbital decompression for thyroid-associated orbitopathy (TAO) via large-scale retrospective analysis, and to optimize surgical strategies accordingly.

A retrospective cohort study included 199 TAO patients (263 eyes) who underwent orbital decompression between September 2021 and June 2025. Patients were stratified into four groups by surgical modality: transconjunctival fat decompression, endoscopic transnasal medial wall decompression, combined transconjunctival medial-lateral wall decompression, and combined endoscopic transnasal medial-lateral wall decompression. Primary outcomes were changes in LogMAR best-corrected visual acuity (BCVA), proptosis, and intraocular pressure (IOP); secondary outcomes included ocular motility, diplopia, and postoperative complication rates.

All surgical strategies resulted in significant clinical improvements. Overall mean proptosis was reduced from 21.16 ± 2.75 mm to 15.01 ± 1.86 mm (p < 0.0001). Mean BCVA improved from 0.67 ± 0.68 LogMAR to 0.34 ± 0.42 LogMAR (p < 0.0001), with the most significant improvement seen in patients with preoperative Dysthyroid Optic Neuropathy (DON). DON was present in 46.4% of eyes, with the highest prevalence in Groups 2 (76.6%) and 4 (62.2%). Combined bony wall decompression (Groups 3 & 4) yielded the greatest proptosis reduction (7.67 mm and 7.29 mm, respectively), significantly more than single-modality decompression (p < 0.0001). The overall complication rate was 9.1%, with new-onset or worsening diplopia being the most common, but often transient or successfully managed with subsequent strabismus surgery. Endoscopic medial wall decompression (Group 2) was associated with the lowest complication rate (4.3%).

In this large single-centre retrospective cohort, individualized orbital decompression was associated with significant improvements in proptosis, visual function, IOP, ocular motility, and diplopia-related outcomes in patients with TAO. Combined medial-lateral wall decompression achieved greater proptosis reduction, whereas procedures involving medial wall decompression were associated with visual improvement in eyes with DON. These findings support an indication-driven approach to surgical selection, while the retrospective design, baseline differences among groups, and eye-level analysis should be considered when interpreting comparative results.