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Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy
PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbit...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Ophthalmological Society
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913973/ https://www.ncbi.nlm.nih.gov/pubmed/24505195 http://dx.doi.org/10.3341/kjo.2014.28.1.1 |
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author | Lee, Kyou Ho Jang, Sun Young Lee, Sang Yeul Yoon, Jin Sook |
author_facet | Lee, Kyou Ho Jang, Sun Young Lee, Sang Yeul Yoon, Jin Sook |
author_sort | Lee, Kyou Ho |
collection | PubMed |
description | PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. RESULTS: Four types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 ± 2.8 mm) was reduced significantly at six months postoperatively (16.1 ± 2.3 mm). Proptosis significantly decreased with a mean of 4.3 ± 1.7 mm, and the reduction was greatest (5.1 ± 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. CONCLUSIONS: Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis. |
format | Online Article Text |
id | pubmed-3913973 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | The Korean Ophthalmological Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-39139732014-02-06 Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy Lee, Kyou Ho Jang, Sun Young Lee, Sang Yeul Yoon, Jin Sook Korean J Ophthalmol Original Article PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. RESULTS: Four types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 ± 2.8 mm) was reduced significantly at six months postoperatively (16.1 ± 2.3 mm). Proptosis significantly decreased with a mean of 4.3 ± 1.7 mm, and the reduction was greatest (5.1 ± 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. CONCLUSIONS: Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis. The Korean Ophthalmological Society 2014-02 2014-01-21 /pmc/articles/PMC3913973/ /pubmed/24505195 http://dx.doi.org/10.3341/kjo.2014.28.1.1 Text en © 2014 The Korean Ophthalmological Society http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Lee, Kyou Ho Jang, Sun Young Lee, Sang Yeul Yoon, Jin Sook Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy |
title | Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy |
title_full | Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy |
title_fullStr | Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy |
title_full_unstemmed | Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy |
title_short | Graded Decompression of Orbital Fat and Wall in Patients with Graves' Orbitopathy |
title_sort | graded decompression of orbital fat and wall in patients with graves' orbitopathy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913973/ https://www.ncbi.nlm.nih.gov/pubmed/24505195 http://dx.doi.org/10.3341/kjo.2014.28.1.1 |
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