Temporal hollowing and other adverse effects after lateral orbital wall decompression.
OBJECTIVE
To evaluate the outcome and late postoperative complications after lateral orbital wall decompression in a series of patients with thyroid eye disease (TED).


METHODS
One hundred and three patients operated in the period 1999-2013 were invited to participate in the study, and 84 were included after a median (range) follow-up time of 124 (13-188) months. The patients were interviewed, and preoperative and postoperative data were collected from hospital records. Photographs ('selfies') were obtained from 64 patients. Wilcoxon signed-rank test was used to evaluate the change in pre- and postoperative data.


RESULTS
On average, visual acuity was unchanged with a median value (range) of 1.0 (0.4-1.25) before to 1.0 (0-1.25) after surgery (p = 0.5). Intraocular pressure (IOP) was reduced from a median value (range) of 17 (9-26) to 15 (8-23) mmHg (p < 0.001). Median (range) Hertel values were 23 (15-30) mm preoperatively and 20 (12-26) mm postoperatively (p < 0.001) respectively. Mean (SD) reduction in proptosis was 3.6 (±2.1) mm. Oscillopsia was reported in 24 patients (29%), 42 (50%) experienced a change in temporal sensation, and four (5%) had new-onset diplopia. In 47 patients (56%), some degree of temporal hollowing was reported. Among 64 photographed patients, 38 (59%) had noticeable hollowing on examination of postoperative pictures. There was agreement of the patient's perception of temporal hollowing and the appearance in photographs in 26 of 37 patients (70%).


CONCLUSIONS
Lateral orbital wall decompression has been considered a safe and effective procedure for treatment of TED. Serious side-effects are infrequent, but in rare circumstances, even blindness may occur. Less serious side-effects are relatively common. Among others, a significant number of the patients developed temporal hollowing after the procedure. The patients must be informed about the possible complications before surgery.
Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.
Hans Olav
HO
Ueland
Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Olav H
OH
Haugen
Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Eyvind
E
Rødahl
D000293:Adolescent; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D009915:Orbit / Q000601:surgery*; D010781:Photography; D011183:Postoperative Complications; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
oscillopsia; proptosis; temporal hollowing; thyroid eye disease; visual acuity