title: Customized Minimally Invasive Orbital Decompression Surgery Improves Lower Eyelid Retraction and Contour in Thyroid Eye Disease.
abstract: OBJECTIVE
  To investigate the outcome of a customized approach with targeted zygomatic basin bone removal orbital decompression in lower eyelid retraction and contour of patients with thyroid eye disease.
  
  
  METHODS
  In a comparative case series, clinical charts and photos of a consecutive sample of 92 patients with thyroid eye disease submitted to different types orbital decompression were studied. Exophthalmos, midpupil to lower eyelid margin distances (MRD2) at 11 meridians, and globe position were measured and compared according to the types of decompression. Each eyelid was also labeled as within or outside normal limits regarding both contour pattern analysis and MRD2 compared with a control normal range. Eyelid contour and globe position from patients with orbital decompression with zygomatic basin removal were compared with those without basin removal.
  
  
  RESULTS
  A total of 105 orbits from 57 patients met the study inclusion criteria. Ninety-eight orbits had lateral orbital wall decompression and in 53% of these cases, bone in the zygomatic basin was removed. Removal of the zygomatic basin did not significantly enhance decrease in proptosis, but significantly induced vertical globe descent and improved MRD2 (p < 0.05). Preoperatively, 37% of the eyelids were in the normal MRD2 range and 18% within the normal contour range. Preoperatively, 77% had normal MRD2 and 55% normal contour range.
  
  
  CONCLUSIONS
  Our study findings support the practical utility of incorporating a customized approach to orbital decompression, and suggest that an individualized approach with targeted bone removal may obviate the need for additional surgeries such as lower eyelid retraction repair.
authors.affiliation: *Division of Ophthalmology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil; and †Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A.
authors.forename: Allan C
authors.initials: AC
authors.lastname: Pieroni Goncalves
authors.forename: Shivani
authors.initials: S
authors.lastname: Gupta
authors.forename: Mario L R
authors.initials: MLR
authors.lastname: Monteiro
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Douglas
mesh_terms: D000328:Adult; D000368:Aged; D054869:Clinical Audit; D019299:Decompression, Surgical / Q000379:methods*; D005143:Eyelids; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult