Surgical Outcomes of Balanced Deep Lateral and Medial Orbital Wall Decompression in Korean Population: Clinical and Computed Tomography-based Analysis

Abstract

Purpose: To evaluate the clinical outcomes of balanced deep lateral and medial orbital wall decompression and to estimate surgical effects using computed tomography (CT) images in Korean patients with thyroid-associated ophthalmopathy (TAO).

Methods: Retrospective chart review was conducted in TAO patients with exophthalmos who underwent balanced deep lateral and medial orbital wall decompression. Exophthalmos was measured preoperatively and postoperatively at 1 and 3 months. Postoperative complications were evaluated in all study periods. In addition, decompressed bone volume was estimated using CT images. Thereafter, decompression volume in each decompressed orbital wall was analyzed to evaluate the surgical effect and predictability.

Results: Twenty-four patients (48 orbits) with an average age of 34.08 ± 7.03 years were evaluated. The mean preoperative and postoperative exophthalmos at 1 and 3 months was 18.91 ± 1.43, 15.10 ± 1.53, and 14.91 ± 1.49 mm, respectively. Bony decompression volume was 0.80 ± 0.29 cm(3) at the medial wall and 0.68 ± 0.23 cm(3) at the deep lateral wall. Postoperative complications included strabismus (one patient, 2.08%), upper eyelid fold change (four patients, 8.33%), and dysesthesia (four patients, 8.33%). Postsurgical exophthalmos reduction was more highly correlated with the deep lateral wall than the medial wall.

Conclusions: In TAO patients with exophthalmos, balanced deep lateral and medial orbital wall decompression is a good surgical method with a low-risk of complications. In addition, deep lateral wall decompression has higher surgical predictability than medial wall decompression, as seen with CT analysis.

Keywords: Computed tomography; Exophthalmos reduction; Graves ophthalmopathy; Orbital decompression.

Fig. 1. Hertel value at preoperative and postoperative 1 and 3 months (^*paired t-test, ^**paired t-test).

Fig. 2. Partial correlation analysis of decompression volume in medial wall (A) and deep lateral wall (B) with postsurgical exophthalmos reduction. Partial correlation coefficient (partial R) which represent surgical predictability, was higher in deep lateral orbital wall decompression (B, partial R = 0.487) than medial orbital wall decompression (A, partial R = 0.402. ^*p = 0.002, ^**p = 0.011).