title: Endoscopic medial orbital fat decompression for proptosis in type 1 graves orbitopathy.
abstract: OBJECTIVE
  To describe the surgical technique for endoscopic medial orbital fat decompression in type 1 (lipogenic) Graves orbitopathy and report outcomes.
  
  
  METHODS
  Retrospective interventional case review.
  
  
  METHODS
  We reviewed 108 patients (206 orbits) with inactive, type 1 Graves orbitopathy without diplopia, who underwent endoscopic medial orbital fat decompression solely for proptosis reduction. Following endoscopic transethmoid medial orbital wall decompression, extraconal and intraconal orbital fat was removed with a low-suction cutting instrument. All patients were followed up for at least 12 months. Surgical time, preoperative and postoperative Hertel exophthalmometry, incidence of postoperative diplopia within 30-degree visual field in the primary gaze, and other complications were analyzed.
  
  
  RESULTS
  The mean surgical time was 97.7 ± 16.7 minutes (67-136 minutes). The mean follow-up was 16.0 ± 4.2 months (12-24 months). Preoperative and postoperative proptosis values at final review were 21.1 ± 2.3 mm (17-26 mm) and 13.0 ± 0.9 mm (12-15 mm), respectively (P < .001). Median reduction in proptosis was 8.0 mm with mean of 8.2 ± 1.8 mm (4-11 mm). Symmetry to within 2 mm was achieved in 106 of 108 patients (98.1%). Twenty-five of 108 patients (23.1%) had diplopia within 30-degree visual field of the gaze, and 23 of these had complete resolution within 3 months, while the remaining 2 patients required squint surgery.
  
  
  CONCLUSIONS
  Endoscopic medial orbital fat decompression may be an effective technique for proptosis in selected patients with type 1 Graves orbitopathy and is associated with a low rate of surgically induced diplopia.
authors.affiliation: Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: wuwencan118@163.com.
authors.forename: Wencan
authors.initials: W
authors.lastname: Wu
authors.affiliation: Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.affiliation: Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Bian
authors.affiliation: Department of Ophthalmology, Jinhua Center Hospital, Jinhua, China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Wang
authors.affiliation: Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Sun
authors.affiliation: Department of Ophthalmology, Lihuili Hospital, Ningbo, China.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Kong
authors.affiliation: Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Wentao
authors.initials: W
authors.lastname: Yan
mesh_terms: D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000503:physiopathology; D004724:Endoscopy / Q000379:methods*; D005094:Exophthalmos / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D049970:Graves Ophthalmopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014794:Visual Fields / Q000502:physiology