Transconjunctival internal decompression of the orbit in patients with endocrine ophthalmopathy: a retrospective analysis

Abstract

BACKGROUND: The most characteristic manifestation of endocrine ophthalmopathy (EO) is the proptosis development in a patient. It is possible to correct the displacement of eyeballs by performing an orbital decompression surgery.

AIM: To evaluate the clinical efficacy of treating patients with endocrine proptosis using transconjunctival internal decompression of the orbit.

MATERIALS AND METHODS: The study included 86 orbits of 43 patients with bilateral proptosis. All patients underwent MSCT examination, proptosis was detected due to an increase in the soft tissue component. Transconjunctival decompression of both eye sockets was performed according to the described method, and the amount of eyeball displacement after surgery was investigated.

RESULTS: Patients’ complaints about constant pressure behind the eye, observed in 39 patients, disappeared during the first day after surgery in 21 patients, in the remaining patients they gradually disappeared within a week. In 32 patients with preoperative diplopia after surgery, in 27 it completely disappeared, in the remaining 5 it remained in the extreme positions. 6 months after surgery, a decrease in proptosis amount from 21.1 ± 1.5 mm to 20.6 ± 1.5 mm was noted, visual acuity was 1.0 ± 0.02, decreased visual acuity remained in 3 cases due to the incipient cataract, IOP decreased from 20 ± 1.2 mm Hg to 19 ± 1.3 mm Hg. There were no eyeball movement restrictions at the control examination.

CONCLUSIONS: Internal (soft tissue) decompression of the orbit is an effective method for proptosis correction exophthalmos in patients with lipid EO form. Carrying out the decompression surgery through the conjunctival access allows to constantly monitor the shape and size of the pupil in the operated orbit, to conduct controlled hemostasis of the orbital tissues. The use of preliminary calculations of the volume of soft tissues to be removed (according to MSCT) makes it possible to obtain a predictable effect of the surgery in variable degrees of proptosis. Transconjunctival decompression helps avoiding cicatricial processes of the eyelid skin.

Keywords

decompression of the socket / endocrine ophthalmopathy / exophthalmos / transconjunctival access

References

[1] Kochetkov PA. Aspects of endocrine ophthalmopathy surgical treatment by ENT specialist. Clinical and experimental thyroidology. 2017;13(3):29–35. (In Russ.) DOI: 10.14341/ket2017329-35

[2] Кочетков П.А. Возможности хирургического лечения эндокринной офтальмопатии. Взгляд оториноларинголога // Клиническая и экспериментальная тиреоидология. 2017. Т. 13, № 3. С. 29–35. DOI: 10.14341/ket2017329-35

[3] Chzhu Vehn’. Otsenka ehffektivnosti razlichnykh metodov dekompressii orbity pri ehndokrinnoi oftal’mopatii [dissertation abstract]. Saint Petersburg, 2022. 22 p. (In Russ.)

[4] Чжу Вэнь. Оценка эффективности различных методов декомпрессии орбиты при эндокринной офтальмопатии: автореф. дис. … канд. мед. наук. Санкт-Петербург, 2022. 22 с.

[5] Kalandari AA. Dekompressiya orbity u patsientov s ehndokrinnoi oftal’mopatiei [dissertation abstract]. Moscow, 2021. 48 p. (In Russ.)

[6] Каландари А.А. Декомпрессия орбиты у пациентов с эндокринной офтальмопатией: автореф. дис. … д-ра мед. наук. Москва, 2021. 48 с.

[7] Brovkina AF, Aubakirova AS. Internal orbital decompression in uncompensated edematous exophthalmos. The Russian annals of ophthalmology. 2006;122(3):3–5. (In Russ.)

[8] Бровкина А.Ф., Аубакирова А.С. Внутренняя декомпрессия орбиты при некомпенсированном отёчном экзофтальме // Вестник офтальмологии. 2006. Т. 122, № 3. С. 3–5.

[9] Aubakirova AS. Dekompressiya orbity kak reabilitatsionnoe meropriyatie pri ehndokrinnoi oftal’mopatii [dissertation abstract]. Moscow, 2007. 22 p. (In Russ.)

[10] Аубакирова А.С. Декомпрессия орбиты как реабилитационное мероприятие при эндокринной офтальмопатии: автореф. дис. … канд. мед. наук. Москва, 2007. 22 с.

[11] Siracuse-Lee DE, Kazim M. Orbital decompression: current concepts. Curr Opin Ophthalmol. 2002;13(5):310–316. DOI: 10.1097/00055735-200210000-00004

[12] Siracuse-Lee D.E., Kazim M. Orbital decompression: current concepts // Curr Opin Ophthalmol. 2002. Vol. 13, No. 5. P. 310–316. DOI: 10.1097/00055735-200210000-00004

[13] Bartalena L, Baldeschi L, Eckstein A, et al. The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J. 2016;5(1):9–26. DOI: 10.1159/000443828

[14] Bartalena L., Baldeschi L., Eckstein A., et al. The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy // Eur Thyroid J. 2016. Vol. 5, No. 1. P. 9–26. DOI: 10.1159/000443828

[15] Li B, Feng L, Tang H, et al. A new radiological measurement method used to evaluate the modified transconjunctival orbital fat decompression surgery. BMC Ophthalmol. 2021;21(1):176. DOI: 10.1186/s12886-021-01911-9

[16] Li B., Feng L., Tang H., et al. A new radiological measurement method used to evaluate the modified transconjunctival orbital fat decompression surgery // BMC Ophthalmol. 2021. Vol. 21, No. 1. ID176. DOI: 10.1186/s12886-021-01911-9

[17] Konovalov KA. Sovershenstvovanie tekhnologii diagnostiki i khirurgicheskogo lecheniya patsientov s ehndokrinnoi oftal’mopatiei [dissertation abstract]. Moscow, 2021. 24 p. (In Russ.)

[18] Коновалов К.А. Совершенствование технологий диагностики и хирургического лечения пациентов с эндокринной офтальмопатией: автореф. дис. … канд. мед. наук. Москва, 2021. 24 с.

[19] Kochetkov PA, Savvateeva DM, Lopatin AS. Orbital decompression: review of surgical approaches and analyse of effective. Russian rhinology. 2013;21(1):28–34. (In Russ.)

[20] Кочетков П.А., Савватеева Д.М., Лопатин А.С. Декомпрессия орбиты: обзор хирургических доступов и анализ их эффективности // Российская ринология. 2013. Т. 21, № 1. С. 28–34.

[21] Davydov DV, Lezhnev DA, Konovalov KA, et al. New method of calculating the excess amount of soft tissues of the orbit in patients with endocrine ophthalmopathy when planning operations. Ophthalmology in Russia. 2019;16(4):442–448. (In Russ.) DOI: 10.18008/1816-5095-2019-4-442-448

[22] Давыдов Д.В., Лежнев Д.А., Коновалов К.А., и др. Новая методика расчёта избыточного объёма мягких тканей орбиты у больных с эндокринной офтальмопатией при планировании операции // Офтальмология. 2019. Т. 16, № 4. С. 442–448. DOI: 10.18008/1816-5095-2019-4-442-448

[23] Brovkina AF, Iatsenko OYu. Rationale for distinguishing the lipogenic form of thyroid orbitopathy. The Russian annals of ophthalmology. 2013;129(2):28–32. (In Russ.)

[24] Бровкина А.Ф., Яценко О.Ю. О целесообразности выделения клинической формы липогенного варианта отёчного экзофтальма // Вестник офтальмологии. 2013. Т. 129, № 2. С. 28–32.

[25] Yatsenko OYu. Volumetric, topographic and structural changes of orbital apex soft tissues in optic neuropathy caused by edematous exophthalmos. Ophthalmology in Russia. 2014;11(2):48–54. (In Russ.) DOI: 10.18008/1816-5095-2014-2-48-54

[26] Яценко О.Ю. Объёмно-топографические и структурные изменения мягких тканей вершины орбиты при оптической нейропатии у пациентов с отёчным экзофтальмом // Офтальмология. 2014. Т. 11, № 2. С. 48–54. DOI: 10.18008/1816–5095-2014-2-48-54

[27] Kacker A, Kazim M, Murphy M, et al. “Balanced” orbital decompression for severe Graves’ orbitopathy: technique with treatment algorithm. Otolaryngol Head Neck Surg. 2003;128(2):228–235. DOI: 10.1067/mhn.2003.61

[28] Kacker A., Kazim M., Murphy M., et al. «Balanced» orbital decompression for severe Graves’ orbitopathy: technique with treatment algorithm // Otolaryngol Head Neck Surg. 2003. Vol. 128, No. 2. P. 228–235. DOI: 10.1067/mhn.2003.61

[29] Robert P-Y, Camezind P, Adenis J-P. Techniques de decompression graisseuse. J Fr Ophthalmol. 2004;27(7):845–850. DOI: 10.1016/S0181-5512(04)96226-2

[30] Robert P.-Y., Camezind P., Adenis J.-P. Techniques de decompression graisseuse // J Fr Ophthalmol. 2004. Vol. 27, No. 7. P. 845–850. DOI: 10.1016/S0181-5512(04)96226-2

[31] Anikina LK, Astakhov SY, Potemkin VV, et al. Ocular surface and the upper eyelid contour after surgical treatment of upper eyelid retraction in thyroid eye disease. Ophthalmology Journal. 2022;15(2):43–52. (In Russ.) DOI: 10.17816/OV105166

[32] Аникикна Л.К., Астахов С.Ю., Потемкин В.В., и др. Состояние глазной поверхности и контура верхнего века при эндокринной офтальмопатии после хирургического лечения ретракции верхнего века // Офтальмологические ведомости. 2022. Т. 15, № 2. С. 43–52. DOI: 10.17816/OV105166

[33] Olivary N. Transpalpebral decompression operation in endocrine orbitopathy (exophthalmos). Wien Med Wochenschrift. 1988;138: 452–455.

[34] Olivary N. Transpalpebral decompression operation in endocrine orbitopathy (exophthalmos) // Wien Med Wochenschrift. 1988. Vol. 138. P. 452–455.

[35] Olivari N. Transpalpebral decompression of endocrine ophthalmopathy (Graves’ Disease) by removal of intraorbital fat: Experience with 147 Operations over 5 years. Plast Reconst Surg. 1991;87(4):627–641. DOI: 10.1097/00006534-199104000-00004

[36] Olivari N. Transpalpebral decompression of endocrine ophthalmopathy (Graves’ Disease) by removal of intraorbital fat: Experience with 147 Operations over 5 years // Plast Reconst Surg. 1991. Vol. 87, No. 4. P. 627–641. DOI: 10.1097/00006534-199104000-00004

[37] Luis V, Riccardo T, Stefano P, Manlio G. Effectiveness of orbital decompression for endocrine orbitopathy on quality of life: A retrospective study. J Craniomaxillofac Surg. 2021;49(9):867–874. DOI: 10.1016/j.lcms2021.03.001

[38] Luis V., Riccardo T., Stefano P., Manlio G. Effectiveness of orbital decompression for endocrine orbitopathy on quality of life: A retrospective study // J Craniomaxillofac Surg. 2021. Vol. 49, No. 9. P. 867–874. DOI: 10.1016/j.lcms2021.03.001

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