Orbital decompression surgery and horse chestnut seed extract improved superior orbital vein blood flow in patients with thyroid-associated ophthalmopathy

AIM: To evaluate the efficacy and safety of orbital decomposition(OD) surgery in combination with horse chestnut seed extract(HCSE), as compared to OD alone,in patients with thyroid-associated ophthalmopathy(TAO).METHODS: Sixty-two orbits from 62 TAO patients were randomly assigned to OD or OD +HCSE at 1:1 ratio(31received OD alone, 31 received OD +HCSE). Forty-two orbits from 21 healthy subjects were used as controls.Complete ophthalmic examination and color Doppler flow imaging(CDFI) were performed before surgery and 3mo post-surgery on all 62 orbits from the TAO patients.CDFI were also performed on the 42 control orbits. The effect of OD +HCSE and OD alone on TAO orbits was compared on several endpoints, including superior ophthalmic vein blood flow(SOVBF) parameters, subjective assessment, soft tissue involvement, lid retraction,diplopia, eye movement restriction, degree of exophthalmos, and intraocular pressure. The control orbits were used as reference for the SOVBF parameters.RESULTS: OD surgery with or without HCSE improved SOVBF, symptoms and soft tissue involvement,decreased degree of exophthalmos and intraocular pressure in orbits of TAO patients. The OD +HCSE combination led to significantly better improvement of SOVBF than OD alone. The differences between the reductions of SOVBF in the two groups are 1.26 cm/s in max-volecity and 0.52 cm/s in min-volecity(P <0.0001).CONCLUSION: SOVBF is significantly reduced in the orbits affected with TAO, indicating that congestion may be an important factor contributing to TAO pathogenesis.OD surgery improves the SOVBF, and combination of HCSE medication and OD surgery further improved venous return than OD surgery alone.

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.

Therapeutic difference between orbital decompression and glucocorticoids administration as the first-line treatment for dysthyroid optic neuropathy:a systematic review

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy(DON).PubMed,EMBASE,the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies.The primary outcomes were the improvement in visual acuity and responder rate.Secondary outcomes were the proptosis reduction,change in diplopia,and clinical activity score(CAS).One randomized controlled trial,three retrospective case series and one prospective case series met the inclusion criteria.They were divided into intravenous high-dose glucocorticoids(ivGC)group and orbital decompression(OD)group.Both groups demonstrated improvement in visual acuity.In addition,the proportion of patients with improved vision in OD group was higher than that in ivGC group(P<0.001).Post-treatment proptosis reduction was also reported in both groups.Overall,weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively.This study also presented results regarding pre-existing and new-onset diplopia.Apart from diplopia,a wide variety of minor and major complications were noted in 5 included studies.The most common complication in ivGC group and OD group was Cushing's syndrome and epistaxis respectively.The present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing proptosis.However,high-quality,large-sample,controlled studies need to be performed in the future.

Modified endoscopic transnasal orbital apex decompression in dysthyroid optic neuropathy

Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.