title: Endoscopic and transconjunctival orbital decompression for thyroid-related orbital apex compression.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of a combined endoscopic and transconjunctival orbital decompression in patients with thyroid-related orbitopathy with orbital apex compression.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  A sequential series of patients with thyroid-related orbitopathy presenting with orbital apex compressive myopathy with and without optic neuropathy who were undergoing combined endoscopic and transconjunctival decompression by the same surgeons from 1992 to 2001 was reviewed. Patients were regularly evaluated preoperatively and postoperatively over a 3- to 55-month period to record the effects of this approach on visual acuity, Hertel exophthalmometry, and diplopia. Complications and secondary ophthalmological procedures were reviewed.
  
  
  RESULTS
  Between 1992 and 2001, 72 combined endoscopic and transconjunctival decompressions were performed on 41 patients with orbital apex compression. Visual acuity improved in 89.3% of the patients with compressive optic neuropathy (P <.0005) and in 34.1% of those without neuropathy. Proptosis was reduced by 3.65 mm, on average. There was one case of transient intraoperative cerebrospinal fluid extravasation at the site of the optic nerve decompression, and one patient developed epistaxis.
  
  
  CONCLUSIONS
  The study supports the treatment of thyroid-related orbital apex compression with and without compressive optic neuropathy by a combined transconjunctival and endoscopic approach. This approach offers short hospital stays, excellent visual recovery, and minimal complications in patients with thyroid-related orbital apex compressive myopathy and related compressive optic neuropathy. The beneficial effects observed in the patients with visual loss continued to improve over time and were significant (P <.001).
authors.affiliation: Department of Otolaryngology, New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA. sschaefer@nyee.edu
authors.forename: Steven D
authors.initials: SD
authors.lastname: Schaefer
authors.forename: Peyman
authors.initials: P
authors.lastname: Soliemanzadeh
authors.forename: David A
authors.initials: DA
authors.lastname: Della Rocca
authors.forename: Gu-Pei
authors.initials: GP
authors.lastname: Yoo
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Maher
authors.forename: James P
authors.initials: JP
authors.lastname: Milite
authors.forename: Robert C
authors.initials: RC
authors.lastname: Della Rocca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000209:etiology / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005094:Exophthalmos / Q000209:etiology / Q000601:surgery; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000601:surgery*; D009901:Optic Nerve Diseases / Q000150:complications / Q000601:surgery*; D009915:Orbit / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology