Orbital fat decompression techniques

Fat removal orbital decompression (FROD) was first described by Olivari in 1988. Through a blepharoplasty approach, fat pads from the five palpebral pockets, as well as intraconal fat, are carefully removed. The main complications are retrobulbar hemorrhage and postoperative diplopia. The best indications are patients with wide orbits without compressive optic neuropathy. FROD is an inescapable procedure in a balanced approach to surgical orbital decompression.     

Orbital decompression for thyroid orbitopathy

Background: Severe thyroid orbitopathy may result in optic neuropathy, corneal exposure and disfiguring proptosis, Orbital decompression has most commonly been performed for optic neuropathy, but with improved techniques, more patients are undergoing decompression for other indications. Purpose: This report evaluates the results and morbidity of orbital decompression for thyroid orbitopathy performed by one surgeon. Methods: The records of 33 patients (53 orbits) undergoing orbital decompression for thyroid orbitopathy were analysed for changes in visual acuity and colour vision (where the indication was optic neuropathy) and reduction in proptosis. Complications were also analysed. Results: Visual acuity and colour vision improved in all 33 eyes with optic neuropathy in the short term postoperative period (4 weeks), but later deteriorated in five eyes (6.6%) of 4 patients (19%). Proptosis decreased by a mean 5.3 mm (range, 1–10). Diplopia developed or worsened overall in 10 of 33 patients (30%), but only in one of 12 (8%) where the indication was cosmesis or corneal exposure. Diplopia improved in 2 of 33 (6%). All patients with symptomatic diplopia achieved binocular single vision in a useful range after one and sometimes two squint procedures. No patient lost vision as a result of surgery. Conclusions: Orbital decompression is effective in improving vision in most patients with thyroid optic neuropathy, but induces or worsens diplopia in a high proportion of these patients. Proptosis can be effectively and dramatically improved.     

Orbital decompression in Graves-Basedow disease--preliminary report

The aim of the paper is to present our initial experience in surgical treatment of patients with malignant exophthalmos. MATERIAL AND METHOD: from 2001 to 2004, 11 patients with malignant exophthalmos were treated in our Department. Preoperative exophthalmos ranged from 22 to 40mm, asymmetric exophthalmos was diagnosed in 5 cases. Orbital decompression was indicated in patients with ophthalmopathy (11), decreased visual acuity (4), lagophthalmos (3). Decompression included orbital floor, medial and lateral wall in 8 patients, orbital floor and medial wall in 3. RESULTS: in 5 patients exophthalmos decreased 5-8 mm, in 5 cases 2-3 mm, 1 patient remained without improvement. CONCLUSIONS: 1. The treatment of malignant exophthalmos requires multidisciplinary approach. 2 Orbital decompression should be followed by surgical correction of eyelids and eyeball muscles.     

Orbital decompression for thyroid eye disease

The literature regarding orbital decompression for thyroid eye disease is vast, spanning multiple specialty areas including neurosurgery, head and neck, maxillofacial, and ophthalmic plastic surgery. Although techniques have advanced considerably over the more than 100 years during which this procedure has been performed, the 4 major approaches remain: transorbital, transcranial, transantral, and transnasal. The explosion in literature related to orbital decompression has mostly involved minor technical variations on broader surgical themes. The purpose of this review is to organize the major approaches in terms of bony anatomy and to contextualize variation in transdisciplinary techniques within a common conceptualization.     

Orbital decompression for Graves' orbitopathy in England

Aims

The purpose of this study was to obtain data on orbital decompression procedures performed in England, classed by hospital and locality, to evaluate regional variation in care.

Methods

Data on orbital decompression taking place in England over a 2-year period between 2007 and 2009 were derived from CHKS Ltd and analysed by the hospital and primary care trust.

Results and conclusions

In all, 44% of these operations took place in hospitals with an annual workload of 10 or fewer procedures. Analysis of the same data by primary care trust suggests an almost 30-fold variance in the rates of decompression performed per unit population. Expertise available to patients with Graves'' orbitopathy and rates of referral for specialist care in England appears to vary significantly by geographic location. These data, along with other outcome measures, will provide a baseline by which progress can be judged.     

Orbital decompression and motility disturbances in endocrine ophthalmopathy

The changes in ocular motility in 15 patients with endocrine ophthalmopathy before and after orbital decompression according to Ogura-Walsh are discussed. The conclusion is that decompression of the orbita gives rise to a considerable risk of development or increase of limitations of ocular movements, with diplopia as a result.     

Fuchs heterochromic cyclitis: current concepts

The clinical features of Fuchs' heterochromic cyclitis (F.H.C.) were described thoroughly by him in 1906. Supplementary data was then supplied by Amsler and Verrey with respect to the vascular characteristics of this disease. Fuchs' disease is not a frequent affection and accounts for no more than 1-2% of the total cases of uveitis. The diagnosis is very difficult to establish at an early stage of the disease. Incomplete or atypical forms are frequent and differential diagnosis is difficult from other cases of cyclitis and/or intermediate uveitis. Furthermore, heterochromia is recognized with difficulty in brown-eyed people. The time of onset of the 3 main symptoms (cataract, heterochromia and cyclitis) varies considerably and the possibility that each of the symptoms follows an individual course at least for a certain period, cannot be excluded. Paraclinical and biological methods for investigating the disease are still limited. However immunological techniques have established the frequent incidence of immune complexes in the aqueous, while some anomalies in the vascular system have been detected on fluoroangiography of the iris. A congenital predisposition to this disease may explain the fact that F.H.C. is generally unilateral. Additionally it might explain Amsler's findings. The way to establish a link both in time and space between all these findings (so as to build up a unique theory which could explain different symptoms) is still unknown, but the so-called sympathetic theory and its theoretical consequences could be rejected permanently in the future.     

Limited macular translocation: current concepts

Macular translocation is a promising treatment modality that offers patients a chance to improve their vision, potentially to a level that may allow reading and driving. Proper patient selection avoids surgery in eyes with permanently damaged central retina and identifies eyes with the greatest potential for good visual outcomes. Functionally, those patients with recent-onset subfoveal CNV without permanent foveal neurosensory retina damage have the greatest likelihood of good visual outcome. Use of fixation evaluation by means of the SLO appears to greatly optimize patient selection. Anatomically, the best candidates have small minimum desired translocations and healthy RPE-Bruch membrane-choriocapillaris complex beyond the borders of the lesion. The exact role of limited macular translocation for the management of subfoveal CNV in this era of photodynamic therapy remains to be evaluated, and a pilot multicenter, randomized, clinical trial is under way to compare the efficacy of limited macular translocation with photodynamic therapy in eyes with subfoveal CNV secondary to AMD.     

Orbital decompression for dysthyroid orbitopathy: a review of techniques and indications

Orbital bony decompression has a definite place in the management of severe manifestations of dysthyroid orbitopathy such as optic neuropathy, exposure keratitis, and exophthalmos. This surgical procedure can be undertaken when medication and radiation therapy fail. Esthetic and functional results are globally satisfying and explain the interest taken in this technique. This article will describe the development of this procedure and will outline the surgical techniques and their complications. It emphasizes the multifactor indications for this procedure.     

眼眶减压术治疗甲状腺功能障碍性视神经病变

甲状腺功能障碍性视神经病变(dysthyroid optic neuropathy,DON)是甲状腺相关眼病的严重并发症之一。DON由于多病因导致眶内容物增多、眶内压增高,如延误治疗会造成不可逆性视力丧失。及时行眼眶减压术降低眶内压、减弱疾病活动性是治疗DON抢救视力、改善眼突度等的关键。眼眶减压术包括眼眶眶壁去除减压术、眶内脂肪切除减压术等。近年术式有所改进,包括深外侧壁减压术、内外壁平衡减压术、三壁最大化眶减压术、微创硬膜外眼眶减压术、鼻内镜下不同入路眶壁减压术、计算机辅助减压术、多种术式联合减压等,以期得到更好的治疗效果。(国际眼科纵览,2020,44:431-437)     

Orbital decompression for Grave's disease leaving the periosteum intact

A prospective trial was carried out to determine whether or not transorbital floor and medial wall decompression without opening the orbital periosteum would relieve compressive optic neuropathy in patients with Grave's disease. In four orbits (three patients), the procedure was performed, and in all cases, the vision returned to 20/30 or better. All other parameters of optic nerve function improved as well. No patient had worsening of ocular motility that was attributable to the surgery. The amount of retroplacement of the globe may be less than with standard orbital decompression.     

Orbital decompression for gross proptosis associated with orbital lymphangioma

A 14-year-old boy with 11 mm of proptosis and exposure keratopathy secondary to an orbital lymphangioma underwent surgical debulking with a carbon dioxide laser through a lateral orbitotomy combined with a 3-wall orbital decompression. The proptosis was reduced by approximately 2 mm as a result of the debulking procedure, but a further 5 mm reduction was achieved with the orbital decompression. No serious adverse effects were encountered. Bony orbital decompression may be a useful alternative treatment in patients with severe proptosis secondary to orbital lymphangioma.     

Orbital decompression in graves disease: indications, techniques, results and complications

BACKGROUND: The surgical rehabilitation of patients with Graves disease involves orbital decompression and various lid and extraocular muscle procedures. METHODS: We have reviewed the literature and include a presentation of our own results. RESULTS: The indications for orbital decompression include not only functional reasons (optic neuropathy, keratopathy, glaucoma, pain) but also aesthetic and psychosocial reasons without visual problems. Current techniques for orbital decompression (bone versus fat removal) are described and discussed. Results demonstrating a mean reduction of proptosis (4 - 6 mm) and complications (mainly diplopia in 3 - 12 %) are presented for coronal and transconjunctival approaches and compared with other methods. Conclusion: Current techniques of orbital decompression are effective and safe and are therefore increasingly used not only for functional but also for aesthetic or "rehabilitative" indications.