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Results of diplopia and strabismus in patients with severe thyroid ophthalmopathy after orbital decompression.

Roncevic R, Savkovic Z, Roncevic D - Indian J Ophthalmol (2014)

Bottom Line: All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average], reduction of intraocular pressure, marked improvement in ocular muscle function as well as considerable reduction in or disappearance of subjective symptoms.There was an improvement in vision in 68% patients who had impaired vision before the operation.Less evident relapse of exophthalmos was recorded in 3 cases only and only one patient required unilateral reoperation.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Revida Hospital, Belgrade, Serbia.

ABSTRACT

Purpose: It has been frequently stated that the orbital decompression, in patients with thyroid ophthalmopathy, does not usually improve extraocular muscles function and that after the operation there is often a deterioration of these functions. The purpose of this article is evaluation of extraocular muscles function after applying personal method of 3 wall orbital decompression.

Materials and methods: Retrospective review of case records of 119 patients with severe thyroid ophthalmopathy seen and treated by the author between December 1986 and December 2010. All patents underwent 3 wall orbital decompression combined with removal of the periorbital, intraorbital and retrobulbar fat. Correction of coexistent eyelid retraction and deformities were also performed.

Results: Comparison of preoperative and postoperative results was conducted in 65 patients three months after 3 wall decompression. All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average], reduction of intraocular pressure, marked improvement in ocular muscle function as well as considerable reduction in or disappearance of subjective symptoms. There were no cases of subsequent impairment of ocular motility. Strabismus surgery was performed in 6 patients with residual diplopia. There was an improvement in vision in 68% patients who had impaired vision before the operation. Less evident relapse of exophthalmos was recorded in 3 cases only and only one patient required unilateral reoperation.

Conclusion: It can be concluded that this method of orbital decompression is logical, based on an understanding of the pathology, has less complication rates, is relatively easy to perform, gives very good functional and aesthetic long term results and allows rapid recovery.

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Patient with exophthalmos of 28 mm, strabismus, diplopia and eyelid deformities, before (a) and 3 months after the operation (b), without diplopia
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Figure 2: Patient with exophthalmos of 28 mm, strabismus, diplopia and eyelid deformities, before (a) and 3 months after the operation (b), without diplopia

Mentions: Using described method of orbital decompression, all symptoms and manifestations of TO disappeared or were significantly decreased. Although the results are evident immediately after operation, the definitive results were obtained in 2 to3 months thereafter. The complete comparisons of preoperative and postoperative results were conducted in 65 patients three months after operation. Postoperatively, in all patients subjective symptoms were considerably reduced or have disappeared. The swelling and deformities of the eyelids disappeared or were significantly reduced. Due to unsatisfactory correction of the upper eyelid retraction it was necessary to perform lengthening of the upper eyelid in four patients and correction of lower eyelid deformity in three patients Conjunctival hyperemia and chemosis, as well exposure keratitis got resolved in all patients. All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average] with marked improvement or normalization of ocular muscle function [Figs. 2–7, Tables 1 and 2]. There were no cases of subsequent impairment of ocular motality, diplopia and strabismus. Due to unsatisfactory correction of double vision and because of residual diplopia, strabismus surgery was performed in six patients. Out of 129 TO orbits in which decompression was performed, there was impairment of vision in 67 eyes due to optic neuropathy or/and due to corneal change. After the operation, the majority of these patients [68%] showed improvement of vision and improvement or elimination of the field defect [Table 3]. In all patients with partial atrophy of disc and irreversible changes in the cornea, there was no improvement of vision. In only one patient the subsequent unilateral impairment of vision occurred. The intraocular pressure measured by mmHg before the operation was 12 to30, mostly 23 to27, the average being 23. After the operation the pressure was 12 to23, mostly 12 to19, average being 15. Until now, less evident relapse was recorded in only 3 cases out of total patients group and in only one patient was unilateral reoperation required [removal of fibrous tissue from bony defects of the orbital walls, which were done in the previous surgery, as well as eventual widening of these bony defects]. Echography, CT and MRI scans showed great reduction of extraocular muscle thickening and shortening of the retrobulbar cone in all operated patients. Finally, significant aesthetic improvement has been achieved in all patients [Figs. 2–7].


Results of diplopia and strabismus in patients with severe thyroid ophthalmopathy after orbital decompression.

Roncevic R, Savkovic Z, Roncevic D - Indian J Ophthalmol (2014)

Patient with exophthalmos of 28 mm, strabismus, diplopia and eyelid deformities, before (a) and 3 months after the operation (b), without diplopia
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061660&req=5

Figure 2: Patient with exophthalmos of 28 mm, strabismus, diplopia and eyelid deformities, before (a) and 3 months after the operation (b), without diplopia
Mentions: Using described method of orbital decompression, all symptoms and manifestations of TO disappeared or were significantly decreased. Although the results are evident immediately after operation, the definitive results were obtained in 2 to3 months thereafter. The complete comparisons of preoperative and postoperative results were conducted in 65 patients three months after operation. Postoperatively, in all patients subjective symptoms were considerably reduced or have disappeared. The swelling and deformities of the eyelids disappeared or were significantly reduced. Due to unsatisfactory correction of the upper eyelid retraction it was necessary to perform lengthening of the upper eyelid in four patients and correction of lower eyelid deformity in three patients Conjunctival hyperemia and chemosis, as well exposure keratitis got resolved in all patients. All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average] with marked improvement or normalization of ocular muscle function [Figs. 2–7, Tables 1 and 2]. There were no cases of subsequent impairment of ocular motality, diplopia and strabismus. Due to unsatisfactory correction of double vision and because of residual diplopia, strabismus surgery was performed in six patients. Out of 129 TO orbits in which decompression was performed, there was impairment of vision in 67 eyes due to optic neuropathy or/and due to corneal change. After the operation, the majority of these patients [68%] showed improvement of vision and improvement or elimination of the field defect [Table 3]. In all patients with partial atrophy of disc and irreversible changes in the cornea, there was no improvement of vision. In only one patient the subsequent unilateral impairment of vision occurred. The intraocular pressure measured by mmHg before the operation was 12 to30, mostly 23 to27, the average being 23. After the operation the pressure was 12 to23, mostly 12 to19, average being 15. Until now, less evident relapse was recorded in only 3 cases out of total patients group and in only one patient was unilateral reoperation required [removal of fibrous tissue from bony defects of the orbital walls, which were done in the previous surgery, as well as eventual widening of these bony defects]. Echography, CT and MRI scans showed great reduction of extraocular muscle thickening and shortening of the retrobulbar cone in all operated patients. Finally, significant aesthetic improvement has been achieved in all patients [Figs. 2–7].

Bottom Line: All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average], reduction of intraocular pressure, marked improvement in ocular muscle function as well as considerable reduction in or disappearance of subjective symptoms.There was an improvement in vision in 68% patients who had impaired vision before the operation.Less evident relapse of exophthalmos was recorded in 3 cases only and only one patient required unilateral reoperation.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Revida Hospital, Belgrade, Serbia.

ABSTRACT

Purpose: It has been frequently stated that the orbital decompression, in patients with thyroid ophthalmopathy, does not usually improve extraocular muscles function and that after the operation there is often a deterioration of these functions. The purpose of this article is evaluation of extraocular muscles function after applying personal method of 3 wall orbital decompression.

Materials and methods: Retrospective review of case records of 119 patients with severe thyroid ophthalmopathy seen and treated by the author between December 1986 and December 2010. All patents underwent 3 wall orbital decompression combined with removal of the periorbital, intraorbital and retrobulbar fat. Correction of coexistent eyelid retraction and deformities were also performed.

Results: Comparison of preoperative and postoperative results was conducted in 65 patients three months after 3 wall decompression. All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average], reduction of intraocular pressure, marked improvement in ocular muscle function as well as considerable reduction in or disappearance of subjective symptoms. There were no cases of subsequent impairment of ocular motility. Strabismus surgery was performed in 6 patients with residual diplopia. There was an improvement in vision in 68% patients who had impaired vision before the operation. Less evident relapse of exophthalmos was recorded in 3 cases only and only one patient required unilateral reoperation.

Conclusion: It can be concluded that this method of orbital decompression is logical, based on an understanding of the pathology, has less complication rates, is relatively easy to perform, gives very good functional and aesthetic long term results and allows rapid recovery.

Show MeSH
Related in: MedlinePlus