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Zwei-Wand-Dekompression ohne Resektion der medialen Wand

Einfluss auf den Schielwinkel

Two-wall decompression without resection of the medial wall

Effect on squint angle

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Zusammenfassung

Hintergrund

Postoperative, neu auftretende Diplopie kann ein Nachteil der chirurgischen Orbitadekompression bei Patienten mit Exophthalmus bei endokriner Orbitopathie sein. Die verschiedenen Modifikationen der Dekompression (Anzahl und Kombination der Wände) unterscheiden sich in ihrem Einfluss auf den postoperativen Schielwinkel. Wir berichten über postoperative Diplopie bei einer modifizierten 2-Wand-Dekompressionsstrategie (laterale Wand und Boden).

Methode

Retrospektive Analyse von 36 konsekutiven 2-Wand-Dekompressionen zwischen 2006 und 2010 bei 24 Patienten mit über 6 Monate stabilem Exophthalmus bei endokriner Orbitopathie nach medikamentöser Therapie und Strahlentherapie. Auswertung von prä- und postoperativem Schielwinkel im Prismen-Cover-Test, Motilität, Induktion von Diplopie, Exophthalmusreduktion, Sehschärfe und Komplikationen.

Ergebnisse

Nach allen 36 Dekompressionen war der postoperative Schielwinkel gleich oder kleiner als präoperativ. Bei 8 Augen wurde eine zusätzliche Schieloperation durchgeführt. Die mittlere Reduktion des Exophthalmus betrug 4,3 mm.

Schlussfolgerungen

Ein nachteiliger Einfluss der Dekompression auf den postoperativen Schielwinkel war in dieser Studie nicht erkennbar. Neuinduktion von Diplopie wurde überhaupt nicht beobachtet. Eine mögliche Erklärung ist die Erhaltung der medialen Wand.

Abstract

Background

Postoperative new onset diplopia can be a disadvantage for surgical orbital decompression in patients with exophthalmos in thyroid eye disease. The various modifications of decompression (number and combination of walls) differ in their influence on the postoperative squint angle. We report on postoperative diplopia in a modified 2 wall decompression strategy (lateral wall and floor).

Methods

This study was a retrospective analysis of 36 consecutive 2-wall decompressions performed between 2006–2010 in 24 patients with 6 months of stable exophthalmos in thyroid eye disease after medical therapy and radiotherapy. The preoperative and postoperative squint angle in prism cover test (PCT), motility, induction of diplopia, reduction of exophthalmos, visual acuity and complications were evaluated.

Results

In all 36 decompressions the postoperative squint angle was equal to or less than before surgery. In 8 eyes additional squint surgery was performed. The mean reduction in exopthalmos was 4.3 mm.

Conclusions

An adverse effect of decompression on the postoperative squint angle was not evident in this study. New induction of diplopia was not observed at all. One possible explanation is the preservation of the medial wall.

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Authors and Affiliations

  1. Augenklinik, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    E. Bertelmann & K. Rüther

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  1. E. Bertelmann
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  2. K. Rüther
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Correspondence to E. Bertelmann.

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Bertelmann, E., Rüther, K. Zwei-Wand-Dekompression ohne Resektion der medialen Wand. Ophthalmologe 108, 1032–1038 (2011). https://doi.org/10.1007/s00347-011-2405-y

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  • DOI: https://doi.org/10.1007/s00347-011-2405-y

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