Strategies in Surgical Decompression for Thyroid Eye Disease
Journal
Oxidative Medicine and Cellular Longevity
Journal Volume
2020
Pages
3537675
Date Issued
2020
Author(s)
Abstract
Surgical management of thyroid eye disease- (TED-) associated morbidity has been plagued by the complex interplay of different operative techniques. Orbital decompression is the well-recognized procedure for disfiguring exophthalmos and dysthyroid optic neuropathy (DON). There are numerous published techniques described for the removal of the orbital bone, fat, or a combination. The diverse studies are noncomparative as they include different indications, stages of disease, and methods of evaluation. Thus, it is difficult to conclude the most efficient decompression technique. To obtain effective and predictable results, it is therefore important to propose a logical and acceptable clinical guideline to customize patient treatment. Herein, we developed an algorithm based on the presence of DON, preoperative existing diplopia, and severity of proptosis which were defined by patient's disabling symptoms together with a set of ocular signs reflecting visual function or cosmesis. More specifically, we aimed to assess the minimal but effective surgical technique with acceptable potential complications to achieve therapeutic efficacy. Transcaruncular or inferomedial decompressions are indicated in restoring optic nerve function in patients with DON associated with mild or moderate to severe proptosis, respectively. Inferomedial or fatty decompressions are effective to treat patients with existing diplopia associated with mild or moderate to severe proptosis, respectively. Fatty or balanced decompressions can improve disfiguring exophthalmos in patients without existing diplopia associated with mild to moderate or severe proptosis, respectively. Inferomedial or 3-wall decompressions are preferred to address facial rehabilitation in patients associated with very severe proptosis but without preoperative diplopia. ? 2020 Anny M. S. Cheng et al.
SDGs
Other Subjects
Eye protection; Surgery; Clinical guideline; Eye disease; Optic nerve; Optic neuropathies; Surgical management; Surgical techniques; Therapeutic efficacy; Visual functions; Patient rehabilitation; algorithm; Article; clinical decision making; decompression surgery; diplopia; disease severity; endocrine ophthalmopathy; exophthalmos; human; endocrine ophthalmopathy; exophthalmos; Evaluation; Management; Optical Materials; Processing; Removal; Restoration; Set; Techniques; Clinical Decision-Making; Decompression, Surgical; Exophthalmos; Graves Ophthalmopathy; Humans
Publisher
Hindawi Limited
Type
journal article