[Development of ocular motility following modified 3-wall decompression of the orbita in endocrine orbitopathy for functional and rehabilitative indication].
BACKGROUND
Permanent visual damage due to an increase in volume of the orbital contents may be the result of the failure of conservative therapeutic concepts in the treatment of endocrine orbitopathy. Considerable progress has been achieved in developing successful orbital decompression techniques with regard to functional and cosmetic outcome. Decompression techniques with resection of the bony orbital walls are adequate tools in restoring visual acuity and reducing exophthalmus. A considerable degree of deterioration of motility disorders has been described in the literature depending on the techniques being used.


OBJECTIVE
The purpose of this study was to investigate whether a modified technique of 3-wall orbital decompression with preservation of a medial part of the periorbital tissue to support the medial rectus muscle, is able to reduce the postoperative risk of diplopia.


METHODS
A modified technique of orbital 3-wall decompression with resection of the medial orbital wall, the medial orbital floor and the floor of the frontal sinus has been used in patients with compressive optic neuropathy (n = 20) and for cosmetic reasons (n = 7) in cases of uni- or bilateral proptosis. Analysis of the results was performed concerning visual outcome, exophthalmus reduction and development of horizontal and vertical motility changes.


RESULTS
In all cases of optic neuropathy improvement of visual function at an average of 4.63 +/- 4.5 lines could be achieved. Exophthalmus reduction was 3.2 +/- 2.4 mm in the functional group and 3.9 +/- 1.7 mm in the rehabilitative group. In this group motility of the medial rectus muscle remained unaffected except in one eye. In the functional group motility deterioration was observed in 62 %.


CONCLUSIONS
The modified 3-wall decompression technique with preservation of a medial periorbital tissue strip is an adequate alternative technique in the therapy of optic neuropathy and exophthalmus reduction in endocrine orbitopathy with a low risk of postoperative motility disorders.
Grenzebach
Ulrike H
UH
Klinik und Poliklinik für Augenheilkunde, Universität Münster.
Schnorbus
Ulrike
U
Büchner
Thomas
T
Busse
Holger
H
Stoll
Wolfgang
W
D000273:Adipose Tissue / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000209:etiology / Q000503:physiopathology; D005626:Frontal Sinus / Q000601:surgery; D006111:Graves Disease / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D009408:Nerve Compression Syndromes / Q000503:physiopathology / Q000601:surgery; D015835:Ocular Motility Disorders / Q000503:physiopathology / Q000601:surgery*; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery; D009900:Optic Nerve / Q000503:physiopathology; D009901:Optic Nerve Diseases / Q000503:physiopathology / Q000601:surgery; D009915:Orbit / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology