Medial wall orbital decompression surgery for the treatment of Graves' ophthalmopathy: follow-up results in a single medical center

Abstract

Purpose: To examine the success rate of endoscopic decompression surgery in Graves' ophthalmopathy.

Methods: This is a retrospective cohort study of all patients who underwent endoscopic decompression surgery at the Rabin Medical Center, Israel, between 2010 and 2022. The data includes post-surgery follow-up time, visual acuity, proptosis outcomes, and post-surgical complications.

Results: Thirty patients underwent unilateral or bilateral decompression surgery at our medical centre during the study period, a total of 42 eyes. The mean age at the time of decompression was 49 ± 15.82 years. The reason for surgery was proptosis in twenty-eight patients (93.3%), while only two patients (6.67%) were referred to surgery due to compressive optic neuropathy. The medial wall was decompressed in all of our patients either as a single procedure or in combination with other procedures. Thirteen patients (43.33%) underwent medial wall-only surgery, thirteen patients (43.33%) had medial and lateral wall surgery, and four patients (13.33%) had medial, lateral, and inferior wall decompression. The mean difference between pre-and post-op of the operated eye, measured by Hertel exophthalmometer, was 3.39 ± 2.45 mm (P < 0.001). The mean difference between the operated eye's visual acuity between pre and post-op was 0.04 ± 0.21LogMAR (P = 0.19). The mean follow-up time for the Hertel measurement was 460.10 days (SD = 585.36). We do not report long-term surgical complications.

Conclusion: In the TED (thyroid eye disease) patient, endoscopic medial wall decompression can ensure sufficient orbital decompression while minimising complications. The size of the proptosis should be a factor when planning the surgery.

Keywords: Decompression; Follow-up; Medial wall; Stability; TED.

Fig. 1

Pre and post-operative photos of four patients. A, B Patient 1 (46F, BE medial wall only). C, D Patient 5 (43F, LE medial and lateral walls). E, F Patient 16 (42M, BE medial and lateral walls). G, H Patient 27 (18F, RE*, Medial and lateral walls). BE Both eyes, LE Left Eye, RE Right Eye

Fig. 2

Pre and post-operative axial CT scans. A, B Patients 17 (55M, BE medial and lateral walls). C, D Patient 2 (61M, LE medial wall only). E, F Patient 27 (18F, RE, Medial and lateral walls)