Transcaruncular Orbital Decompression: An Alternate Procedure for Graves Ophthalmopathy With Compressive Optic Neuropathy
Journal
American Journal of Ophthalmology
Journal Volume
141
Journal Issue
5
Pages
810-8180
Date Issued
2006
Author(s)
Abstract
Purpose: To study the efficacy of transcaruncular orbital apex decompression for Graves ophthalmopathy with compressive optic neuropathy nonresponsive to pulse corticosteroids. Design: Retrospective, interventional case series study. Methods: From August 1999 to November 2003, transcaruncular orbital decompression was performed in 22 consecutive Graves ophthalmopathy patients with compressive optic neuropathy refractory to pulse corticosteroids. The average period of corticosteroid treatment was 16.1 ± 5.2 days. Main outcome measures were preoperative and postoperative best-corrected vision, Hertel exophthalmometry, 100-hue color sensation test, visual evoked potential, visual field, and new-onset diplopia. Results: Visual acuity improved significantly from 1.08 ± 0.24 logarithm of minimal angle of resolution (logMAR) preoperatively to 0.29 ± 0.18 logMAR postoperatively (P < .0001). Average improvement in retinal sensitivity was 9.4 ± 8.2 dB, in P100 value of visual evoked potential was 27.5 ± 20.1, and in "total errors" of the 100-hue test was 309.9 ± 214.3 after surgery. Average retroplacement effect was 3.7 ± 1.6 mm. Statistical analysis showed significant differences between preoperative and postoperative measurements for all above parameters (P < .0001). New-onset diplopia occurred in 38% of patients. There were no complications specifically attributable to the transcaruncular technique. Conclusions: The transcaruncular approach offers access to the medial and inferior wall for orbital apex decompression in Graves ophthalmopathy patients with compressive optic neuropathy refractory to pulse corticosteroids. Advantages over other approaches included no external scar, less damage to adjacent tissue, and wide exposure to the entire medial wall. ? 2006 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
corticosteroid; adult; aged; article; clinical article; controlled study; corticosteroid therapy; decompression surgery; diagnostic test; diplopia; endocrine ophthalmopathy; evoked visual response; eye color; female; human; male; optic nerve disease; postoperative period; preoperative period; priority journal; retina; retrospective study; statistical analysis; transcaruncular orbital decompression; treatment duration; vision; visual acuity; visual field
Publisher
Elsevier Inc.
Type
journal article