Orbital decompression surgery for the treatment of Graves＇ ophthalmopathy：comparison of different techniques and long-term results

AIM： To evaluate the long-term results of different orbital decompression techniques performed in patients with Graves＇ ophthalmopathy（GO）.METHODS： Totally 170 cases with GO underwent orbital decompression between 1994 and 2014. Patients were divided into 4 groups as medial-inferior, mediallateral（balanced）, medial-lateral-inferior, and lateral only according to the applied surgical technique. Surgical indications, regression degrees on Hertel exophthalmometer, new-onset diplopia in the primary gaze and new-onset gaze-evoked diplopia after surgery and visual acuity in cases with dysthyroid optic neuropathy（DON） were compared between different surgical techniques.RESULTS： The study included 248 eyes of 149 patients. The mean age for surgery was 42.3±13.2 y. DON was the surgical indication in 36.6% of cases, and three-wall decompression was the most preferred technique in these cases. All types of surgery significantly decrease the Hertel values（P〈0.005）. Balanced medial-lateral, and only lateral wall decompression caused the lowest rate of postoperative new-onset diplopia in primary gaze. The improvement of visual acuity in patients with DON did not significantly differ between the groups（P=0.181）. CONCLUSION： The study show that orbital decompression surgery has safe and effective long term results for functional and cosmetic rehabilitation of GO. It significantly reduces Hertel measurements in disfiguring proptosis and improves visual functions especially in DON cases.

Anatomic and functional results of idiopathic macular epiretinal membrane surgery

AIM: To assess the impact of macular surgery on the functional and anatomic outcomes in patients with grade 2 epiretinal membrane(ERM), and the effect of internal limiting membrane(ILM) peeling on visual acuity and to analyze the long-term effect of pars plana vitrectomy(PPV) on intraocular pressure(IOP).METHODS: Pseudophakic eyes(62 eyes) diagnosed as idiopathic grade 2 ERM with at least 6 mo postoperative follow-up were included in this retrospective study. The fellow eye was nonvitrectomized. Patients were divided into two groups: group 1(29 eyes) treated with ERM and ILM peeling and group 2(33 eyes) with only ERM peeling. Preoperative and postoperative best corrected visual acuity(BCVA), slit-lamp, and a dilated fundus examination was performed. IOP was measured with Goldman applanation tonometer before, day 1 and first week and each visit after surgery. The incidence of significant IOP elevation was compared between vitrectomized eyes and nonvitrectomized fellow eyes.RESULTS: Visual improvement was statistically significant and similar in both groups(P=0.008 in group 1, P=0.002 in group 2, P=0.09 inter-group). The amount of decrease in central macular thickness was statistically significant and similar in both groups(P=0.005 group 1, P=0.008 group 2, P=0.37 intergroup). At the final follow-up(14.1±9.6 mo) the incidence of significant IOP elevation was 4% in vitrectomized eyes(three eyes) and 3%(two eyes) in the nonvitrectomized fellow eyes(P=0.12). Four eyes(12.1%) had recurrent ERM after a mean follow-up of 8.6±1.1 mo in group 2, there was no recurrence in group 1(P=0.01).CONCLUSION: Recurrence of ERM may be decreased by ILM peeling during ERM surgery. However, it seems that ILM peeling do not affect the functional outcome and 23-gauge PPV alone do not have a significant effect on IOP.