Transconjunctival internal decompression of the orbit in patients with endocrine ophthalmopathy: a retrospective analysis

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BACKGROUND: The most characteristic manifestation of endocrine ophthalmopathy (EO) is the proptosis development in a patient. It is possible to correct the displacement of eyeballs by performing an orbital decompression surgery.

AIM: To evaluate the clinical efficacy of treating patients with endocrine proptosis using transconjunctival internal decompression of the orbit.

MATERIALS AND METHODS: The study included 86 orbits of 43 patients with bilateral proptosis. All patients underwent MSCT examination, proptosis was detected due to an increase in the soft tissue component. Transconjunctival decompression of both eye sockets was performed according to the described method, and the amount of eyeball displacement after surgery was investigated.

RESULTS: Patients’ complaints about constant pressure behind the eye, observed in 39 patients, disappeared during the first day after surgery in 21 patients, in the remaining patients they gradually disappeared within a week. In 32 patients with preoperative diplopia after surgery, in 27 it completely disappeared, in the remaining 5 it remained in the extreme positions. 6 months after surgery, a decrease in proptosis amount from 21.1 ± 1.5 mm to 20.6 ± 1.5 mm was noted, visual acuity was 1.0 ± 0.02, decreased visual acuity remained in 3 cases due to the incipient cataract, IOP decreased from 20 ± 1.2 mm Hg to 19 ± 1.3 mm Hg. There were no eyeball movement restrictions at the control examination.

CONCLUSIONS: Internal (soft tissue) decompression of the orbit is an effective method for proptosis correction exophthalmos in patients with lipid EO form. Carrying out the decompression surgery through the conjunctival access allows to constantly monitor the shape and size of the pupil in the operated orbit, to conduct controlled hemostasis of the orbital tissues. The use of preliminary calculations of the volume of soft tissues to be removed (according to MSCT) makes it possible to obtain a predictable effect of the surgery in variable degrees of proptosis. Transconjunctival decompression helps avoiding cicatricial processes of the eyelid skin.

作者简介

Dmitry Davydov

National Medical Research Radiological Center; Peoples’ Friendship University of Russia

编辑信件的主要联系方式.
Email: d-davydov3@yandex.ru
ORCID iD: 0000-0001-5506-6021

Professor, Head of the Department of Oncoplastic Surgery, Head of the Department of Reconstructive Plastic Surgery with a course of ophthalmology

俄罗斯联邦, Moscow; Moscow

参考

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2. Fig. 1. General appearance of the 25 years old patient before surgery

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3. Fig. 2. MSCT of the patient. Endocrine ophthalmopathy, exophthalmos, lipid type

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4. Fig. 3. Volume of orbital fat removed during decompression

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5. Fig. 4. General appearance of patient F., 1st day post op. Immediately after the bandage removal

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6. Fig. 5. Patient F., 5 days post op. General appearance

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7. Fig. 6. General appearance of the patient, 2 weeks after surgery

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8. Fig. 7. Patient, 1 month after surgery

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9. Fig. 8. General appearance 2.5 months after surgery

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10. Fig. 9. Patient, 6 years post operation: a — general appearance; b — at sideward glance; c — side view

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