title: Endoscopical Orbital Fat Decompression with Medial Orbital Wall Decompression for Dysthyroid Optic Neuropathy.
abstract: OBJECTIVE
  To describe a novel approach to orbital decompression for dysthyroid optic neuropathy (DON).
  
  
  METHODS
  An augmented endoscopic transethmoid medial orbital wall decompression (ETMOWD) was performed on 43 consecutive patients (72 eyes) with DON in order to access the orbital apex adequately. Concurrently, endoscopic transethmoid fat decompression (ETFD) using a novel aspiration/cutting instrument to remove orbital fat was performed for further reduction of proptosis. All patients were followed up periodically for at least 6 months. Outcomes such as improvement of visual acuity (VA), color vision, degree of proptosis reduction as well as the incidence of surgical induced diplopia were analyzed at the final review.
  
  
  RESULTS
  Sixty-nine out of 72 eyes (95.8%) had a statistically significant improvement in VA from -0.65 ± 0.30 to -0.25 ± 0.22 postoperatively, with a mean improvement of 0.55 ± 0.17 (p < 0.001). Thirty-four out of 45 eyes had an improvement in color vision (p < 0.001). The range of proptosis reduction was 4 to 9 mm (mean 6.2 ± 1.2 mm). Postoperative symmetry was achieved to within 2 mm using an exophthalmometer in 39 of 43 patients (90.7%). Five patients developed diplopia in the postoperative phase, but had complete resolution within 3 months. Two patients had further deterioration in their diplopia following surgery.
  
  
  CONCLUSIONS
  Our technique of a combined ETFD with ETMOWD appears to be effective in managing patients with DON, with minimal morbidities and a low incidence of postoperative diplopia.
authors.affiliation: a Department of Ophthalmology , Jinhua Center Hospital , Jinhua , Zhejiang , P.R. China .
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Lv
authors.affiliation: b 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: c Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China and.
authors.forename: Wentao
authors.initials: W
authors.lastname: Yan
authors.affiliation: d Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Pelaez
authors.initials: P
authors.lastname: Daniel
authors.affiliation: c Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China and.
authors.forename: Yunhai
authors.initials: Y
authors.lastname: Tu
authors.affiliation: c Department of Orbital & Oculoplastic Surgery , Eye Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China and.
authors.forename: Wencan
authors.initials: W
authors.lastname: Wu
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000503:physiopathology; D004724:Endoscopy; D005094:Exophthalmos / Q000601:surgery; D005260:Female; D049970:Graves Ophthalmopathy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009901:Optic Nerve Diseases / Q000503:physiopathology / Q000601:surgery*; D009915:Orbit / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Dythyroid optic neuropathy; endoscopic transethomoid medial orbital wall decompression; endoscopic transethomoid orbital fat decompression; proptosis reduction