Transcaruncular orbital decompression: an alternate procedure for Graves ophthalmopathy with compressive optic neuropathy.
OBJECTIVE
To study the efficacy of transcaruncular orbital apex decompression for Graves ophthalmopathy with compressive optic neuropathy nonresponsive to pulse corticosteroids.


METHODS
Retrospective, interventional case series study.


METHODS
From August 1999 to November 2003, transcaruncular orbital decompression was performed in 22 consecutive Graves ophthalmopathy patients with compressive optic neuropathy refractory to pulse corticosteroids. The average period of corticosteroid treatment was 16.1 +/- 5.2 days. Main outcome measures were preoperative and postoperative best-corrected vision, Hertel exophthalmometry, 100-hue color sensation test, visual evoked potential, visual field, and new-onset diplopia.


RESULTS
Visual acuity improved significantly from 1.08 +/- 0.24 logarithm of minimal angle of resolution (logMAR) preoperatively to 0.29 +/- 0.18 logMAR postoperatively (P < .0001). Average improvement in retinal sensitivity was 9.4 +/- 8.2 dB, in P(100) value of visual evoked potential was 27.5 +/- 20.1, and in "total errors" of the 100-hue test was 309.9 +/- 214.3 after surgery. Average retroplacement effect was 3.7 +/- 1.6 mm. Statistical analysis showed significant differences between preoperative and postoperative measurements for all above parameters (P < .0001). New-onset diplopia occurred in 38% of patients. There were no complications specifically attributable to the transcaruncular technique.


CONCLUSIONS
The transcaruncular approach offers access to the medial and inferior wall for orbital apex decompression in Graves ophthalmopathy patients with compressive optic neuropathy refractory to pulse corticosteroids. Advantages over other approaches included no external scar, less damage to adjacent tissue, and wide exposure to the entire medial wall.
Liao
Shu Lang
SL
Department of Ophthalmology, College of Medicine and National Taiwan University Hospital, 7 Chung Shan South Road, Taipei, Taiwan. lang89@ha.mc.ntu.edu.tw
Chang
Tien Chun
TC
Lin
Luke L-K
LL
D000328:Adult; D000368:Aged; D003118:Color Perception / Q000502:physiology; D003119:Color Perception Tests; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000503:physiopathology; D005074:Evoked Potentials, Visual / Q000502:physiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D009901:Optic Nerve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D017211:Treatment Failure; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology
D005938:Glucocorticoids