Orbital decompression: a comparison between trans-fornix/transcaruncular inferomedial and coronal inferomedial plus lateral approaches.
OBJECTIVE
To compare two techniques of orbital decompression for Graves orbitopathy, that is, the inferomedial transfornix/transcaruncular approach and the inferomedial plus lateral coronal approach.


METHODS
Comparative interventional case series. A retrospective review of 53 patients (94 orbits) with Graves orbitopathy operated on over a 9-year period was performed. Forty-nine orbits were decompressed by the transfornix-transcaruncular approach and 45 by the coronal approach. Data obtained for all patients included computed tomography scans of the orbits, Snellen visual acuity measurements, visual fields, Hertel exophthalmometry, color vision testing, subjective testing for diplopia in the cardinal positions of gaze, and direct ophthalmoscopic or biomicroscopic examination of the optic disc.


RESULTS
The mean proptosis reduction was 4.37 mm with the transfornix/transcaruncular approach and 5.76 mm with the 3-wall coronal approach. The rate of optic neuropathy reversal was similar with both techniques (90%). Induction of new diplopia occurred in 13.6% patients operated by the transfornix/transcaruncular approach and in 16.6% patients who underwent decompression by the coronal approach.


CONCLUSIONS
The two techniques have similar effects on visual function and ocular motility. For the vast majority of patients with Graves who need orbital decompression, the coronal approach is unnecessary; the transconjunctival approach allows the same exposure to the medial, inferior, and lateral walls.
Cruz
Antonio Augusto V
AA
Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. aavecruz@fmrp.usp.br
Leme
Valmor Rios
VR
D000328:Adult; D001763:Blepharoptosis / Q000209:etiology / Q000503:physiopathology; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D004172:Diplopia / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009901:Optic Nerve Diseases / Q000209:etiology / Q000503:physiopathology; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D014785:Vision, Ocular; D014792:Visual Acuity