Modified orbital decompression for dysthyroid orbitopathy.
OBJECTIVE
The transantral approach to orbital decompression remains useful for the management of exophthalmos associated with dysthyroid orbitopathy. However, the risk of postoperative diplopia is a concern. Preservation of the anterior periorbita may help support the orbital contents and decrease the incidence of diplopia.


METHODS
The medical records were reviewed of 15 consecutive patients who underwent 30 transantral orbital decompressions for proptosis associated with dysthyroid orbitopathy. The procedures were completed in standard fashion, including removal of the inferomedial bony strut between the medial orbital wall and the floor. However, stripping of the periorbita was only done posteriorly; the anterior 10 to 15 mm of periorbita were left intact.


RESULTS
Six patients had preoperative diplopia that persisted after decompression. Of the nine patients without diplopia preoperatively, none developed diplopia. Proptosis was reduced a mean of 3.5 +/- 2.6 mm.


CONCLUSIONS
Preservation of the anterior periorbita during transantral orbital decompression reduces the risk of postoperative diplopia. An adequate reduction in proptosis is also achieved.
Seiff
S R
SR
Department of Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery Service, University of California San Francisco, USA.
Tovilla
J L
JL
Carter
S R
SR
Choo
P H
PH
D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical; D004172:Diplopia / Q000517:prevention & control; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D013536:Suture Techniques; D016896:Treatment Outcome