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Outcomes of endoscopic orbital decompression for graves’ ophthalmopathy

Irish Journal of Medical Science (1971 -) volume 189, pages 177–183 (2020)Cite this article

Abstract

Background/aims

We assess outcomes of endoscopic orbital decompression for Graves’ ophthalmopathy.

Methods

A review of endoscopic orbital decompressions of the medial and partial inferior wall between July 2004 and July 2017 was carried out. Outcome was assessed by comparing pre- and post-operative measurements of exophthalmometry and visual acuity. Results were evaluated by repeated measures analysis of variance.

Results

A total of 41 orbits in 25 patients underwent endoscopic orbital decompression for Graves’ ophthalmopathy in the time period; however, six orbits in three patients had insufficient data for inclusion. Eleven patients required concurrent septoplasty to allow access. Measurements were taken at a mean of 11 days, 32 days, and 95 days post-operatively. Reduction in mean proptosis was 2.81 mm at 1-month post-decompression and 3.26 mm at 3 months. There was no significant difference between those treated for compressive optic neuropathy compared with those treated for cosmetic reasons. Colour vision by Ishihara plate improved significantly by a mean score of 2.67 post-operatively. Using LogMAR conversion for visual acuity, measured by a best-corrected Snellen chart, improvement of 0.18 was achieved at 1-month post-decompression, equivalent to approximately two lines on the Snellen chart. There was minimal (0.04) further improvement at 3 months. The improvement in visual acuity was greater in cases treated for compressive optic neuropathy than cosmesis, but this did not reach statistical significance (p = 0.06). Three cases required revision surgery. Diplopia disimproved or developed in four cases and squint surgery was required in three cases.

Conclusions

Endoscopic orbital decompression offers an effective, safe and minimally invasive treatment for Graves’ ophthalmopathy. There is a trend towards continued improvement in outcomes over the course of 3 months post-operatively.

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Authors and Affiliations

  1. Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland

    Robbie S. R. Woods, Natallia Kharytaniuk & Conrad V. I. Timon

  2. Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, Ireland

    Qistina Pilson, Lorraine Cassidy & Rizwana Khan

Authors
  1. Robbie S. R. Woods
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  2. Qistina Pilson
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  3. Natallia Kharytaniuk
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  4. Lorraine Cassidy
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  6. Conrad V. I. Timon
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Correspondence to Robbie S. R. Woods.

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This study was approved by the Royal Victoria Eye and Ear Hospital Clinical Audit Committee. All patient data were kept anonymous and encrypted throughout.

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The authors declare that they have no conflict of interest.

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Woods, R.S.R., Pilson, Q., Kharytaniuk, N. et al. Outcomes of endoscopic orbital decompression for graves’ ophthalmopathy. Ir J Med Sci 189, 177–183 (2020). https://doi.org/10.1007/s11845-019-02043-2

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  • DOI: https://doi.org/10.1007/s11845-019-02043-2

Keywords

  • Cosmesis
  • Endoscopic surgery
  • Graves’ ophthalmopathy
  • Optic nerve
  • Orbital decompression