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Critical Appraisal on Orbital Decompression for Thyroid Eye Disease: A Systematic Review and Literature Search.

Boboridis KG, Uddin J, Mikropoulos DG, Bunce C, Mangouritsas G, Voudouragkaki IC, Konstas AG - Adv Ther (2015)

Bottom Line: The relative efficacy and complications of these interventions in relation to the specific indications remain as yet undocumented.One study suggests that the transantral approach and endonasal technique had similar effects in reducing exophthalmos but the latter is safer.The second study provides evidence that intravenous steroids may be superior to primary surgical decompression in the management of compressive optic neuropathy requiring less secondary surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece.

ABSTRACT

Introduction: Orbital decompression is the indicated procedure for addressing exophthalmos and compressive optic neuropathy in thyroid eye disease. There are an abundance of techniques for removal of orbital bone, fat, or a combination published in the scientific literature. The relative efficacy and complications of these interventions in relation to the specific indications remain as yet undocumented. We performed a systematic review of the current published evidence for the effectiveness of orbital decompression, possible complications, and impact on quality of life.

Methods: We searched the current databases for medical literature and controlled trials, oculoplastic textbooks, and conference proceedings to identify relevant data up to February 2015. We included randomized controlled trials (RCTs) comparing two or more interventions for orbital decompression.

Results: We identified only two eligible RCTs for inclusion in the review. As a result of the significant variability between studies on decompression, i.e., methodology and outcome measures, we did not perform a meta-analysis. One study suggests that the transantral approach and endonasal technique had similar effects in reducing exophthalmos but the latter is safer. The second study provides evidence that intravenous steroids may be superior to primary surgical decompression in the management of compressive optic neuropathy requiring less secondary surgical procedures.

Conclusion: Most of the published literature on orbital decompression consists of retrospective, uncontrolled trials. There is evidence from those studies that removal of the medial and lateral wall (balanced) and the deep lateral wall decompression, with or without fat removal, may be the most effective surgical methods with only few complications. There is a clear unmet need for controlled trials evaluating the different techniques for orbital decompression. Ideally, future studies should address the effectiveness, possible complications, quality of life, and cost of each intervention.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of the study process. Search and identification of studies for inclusion in the review
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Related In: Results  -  Collection


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Fig1: Flow diagram of the study process. Search and identification of studies for inclusion in the review

Mentions: The updated electronic searches revealed 1195 titles, 160 more than the published Cochrane review [22]. After removing duplicated and irrelevant results, we scanned 1058 records and discarded 914 titles because they were outside the scope of our review. From the remaining 144 references, there were no additional RCTs identified from the ones that were included in our systematic review (Fig. 1). Clinically meaningful information from the excluded 142 studies supplemented the results in a descriptive outline. Personal communication with the European Group for Graves Ophthalmopathy (EUGOGO) revealed a protocol for RCT comparing three surgical techniques of orbital decompression but this is in the early stages with no study registration yet.Fig. 1


Critical Appraisal on Orbital Decompression for Thyroid Eye Disease: A Systematic Review and Literature Search.

Boboridis KG, Uddin J, Mikropoulos DG, Bunce C, Mangouritsas G, Voudouragkaki IC, Konstas AG - Adv Ther (2015)

Flow diagram of the study process. Search and identification of studies for inclusion in the review
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4522025&req=5

Fig1: Flow diagram of the study process. Search and identification of studies for inclusion in the review
Mentions: The updated electronic searches revealed 1195 titles, 160 more than the published Cochrane review [22]. After removing duplicated and irrelevant results, we scanned 1058 records and discarded 914 titles because they were outside the scope of our review. From the remaining 144 references, there were no additional RCTs identified from the ones that were included in our systematic review (Fig. 1). Clinically meaningful information from the excluded 142 studies supplemented the results in a descriptive outline. Personal communication with the European Group for Graves Ophthalmopathy (EUGOGO) revealed a protocol for RCT comparing three surgical techniques of orbital decompression but this is in the early stages with no study registration yet.Fig. 1

Bottom Line: The relative efficacy and complications of these interventions in relation to the specific indications remain as yet undocumented.One study suggests that the transantral approach and endonasal technique had similar effects in reducing exophthalmos but the latter is safer.The second study provides evidence that intravenous steroids may be superior to primary surgical decompression in the management of compressive optic neuropathy requiring less secondary surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece.

ABSTRACT

Introduction: Orbital decompression is the indicated procedure for addressing exophthalmos and compressive optic neuropathy in thyroid eye disease. There are an abundance of techniques for removal of orbital bone, fat, or a combination published in the scientific literature. The relative efficacy and complications of these interventions in relation to the specific indications remain as yet undocumented. We performed a systematic review of the current published evidence for the effectiveness of orbital decompression, possible complications, and impact on quality of life.

Methods: We searched the current databases for medical literature and controlled trials, oculoplastic textbooks, and conference proceedings to identify relevant data up to February 2015. We included randomized controlled trials (RCTs) comparing two or more interventions for orbital decompression.

Results: We identified only two eligible RCTs for inclusion in the review. As a result of the significant variability between studies on decompression, i.e., methodology and outcome measures, we did not perform a meta-analysis. One study suggests that the transantral approach and endonasal technique had similar effects in reducing exophthalmos but the latter is safer. The second study provides evidence that intravenous steroids may be superior to primary surgical decompression in the management of compressive optic neuropathy requiring less secondary surgical procedures.

Conclusion: Most of the published literature on orbital decompression consists of retrospective, uncontrolled trials. There is evidence from those studies that removal of the medial and lateral wall (balanced) and the deep lateral wall decompression, with or without fat removal, may be the most effective surgical methods with only few complications. There is a clear unmet need for controlled trials evaluating the different techniques for orbital decompression. Ideally, future studies should address the effectiveness, possible complications, quality of life, and cost of each intervention.

No MeSH data available.


Related in: MedlinePlus