title: Orbital Decompression in the Endoscopic Age: The Modified Inferomedial Orbital Strut.
abstract: Postoperative diplopia occurs in up to 45% of patients following orbital decompression for exophthalmos associated with Graves' orbitopathy. We sought to describe outcomes of our balanced orbital decompression strategy that includes the preservation of a modified inferomedial orbital strut (mIOS).
  
  
  
  Case series with chart review.
  
  
  
  Academic medical center.
  
  
  
  A total of 115 consecutive orbital decompressions were performed on 73 patients (42 bilateral) with Graves' orbitopathy. All patients underwent (1) a balanced decompression technique incorporating an endoscopic medial and external lateral decompression and (2) a mIOS technique with preservation of the anterior half of the inferomedial orbital strut. A periorbital periosteal (orbital) sling was utilized in patients (n = 54) without threatened vision loss, proptosis >28 mm, or periorbital disruption to prevent prolapse of the medial rectus muscle.
  
  
  
  Utilization of the mIOS technique with or without a sling did not adversely affect the reduction in proptosis (5.1 mm with sling vs 5.0 mm without sling; P = .85).The incidence of new-onset postoperative diplopia was 17% (n = 6). The sling was not associated with postoperative diplopia (odds ratio = 0.54, 95% confidence interval: 0.08-3.40, P = .51), while it was associated with resolution of preexisting diplopia (odds ratio = 6.67, 95% confidence interval: 1.06-42.06, P = .04). No intraoperative complications occurred, and no patients suffered a decrement in visual acuity.
  
  
  
  Balanced orbital decompression utilizing a mIOS in patients with Graves' orbitopathy provides a safe and effective reduction in proptosis with a low rate of new-onset diplopia as compared with historical values. Utilization of an orbital sling may be beneficial in reducing postoperative diplopia in select patients.
authors.affiliation: Department of Otorhinolaryngology, University of Texas Medical School at Houston, Houston, Texas, USA William.C.Yao@uth.tmc.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Yao
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Yadav
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Fay
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Metson
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D004172:Diplopia / Q000453:epidemiology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014792:Visual Acuity
keywords: Graves’ disease; balanced decompression; endoscopic orbital decompression; orbital decompression; orbital sling; orbital strut