Deep lateral wall combined with medial wall orbital decompression for thyroid associated ophthalmopathy

Abstract

AIM: To explore the clinical effect and safety of deep lateral wall combined with medial wall orbital decompression in the treatment of thyroid associated ophthalmopathy(TAO).METHODS: Totally 17 patients with TAO in our department from January 2019 to May 2020 were included. All patients underwent deep lateral wall combined with medial wall orbital decompression under general anesthesia, the visual acuity, recovery of exposure keratitis, exophthalmos, intraocular pressure and complications were compared before and after operation.RESULTS: Eight patients(9 eyes)with TAO and dysthyroid optic neuropathy(DON)were included in the study. The best corrected visual acuity averaged 0.78±0.15 preoperatively and 0.36±0.12 1mo postoperatively, which was statistically significant(P<0.01)compared with the preoperative visual acuity, 0.38±0.12 at 6mo after surgery, which was not statistically different from that at 1mo after surgery(P=0.594). The mean preoperative proptosis was 23.75±2.55mm and the mean postoperative proptosis was 14.85±1.53mm at 1mo, which was statistically significant compared with the preoperative proptosis(P<0.01), proptosis was on average 14.60±1.64mm at 6mo after surgery and remained generally stable(P=0.658)from 1mo before surgery. The intraocular pressure of the patients was 25.56±3.23mmHg preoperatively and 18.42±2.35mmHg 1mo postoperatively, which was statistically significant compared with the preoperative value(P<0.01), and the intraocular pressure of the patients was reduced to 15.82±2.57mmHg at the 6mo postoperative follow-up, which was statistically significant compared with the intraocular pressure of the patients 1mo postoperatively(P<0.01). There were 6 eyes of 6 patients with exposure keratitis preoperatively, 4 eyes improved and 2 eyes were cured in the 1mo postoperative, and all 6 eyes were cured 6mo postoperatively. Postoperatively, the diplopia of the patients all decreased to various degrees, and there were some patients whose diplopia symptoms continued to improve 6mo thereafter without other serious complications.CONCLUSION: Deep lateral wall combined with medial wall orbital decompression can effectively improve the proptosis and also have a good effect on severe complications such as DON and exposure keratitis with few complications, so deep lateral wall combined with medial wall orbital decompression is an effective surgical procedure in the treatment of severe TAO.

Keywords

• thyroid associated ophthalmopathy
• deep lateral wall
• medial wall
• orbital decompression