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Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis
| Resumo: | INTRODUCTION: Orbital decompression surgery has been widely used in thyroid eye disease (TED). It is performed in the active stage, in sight-threatening cases of dysthyroid compressive optic neuropathy (DON), or severe corneal exposure unresponsive to steroids, and also during the quiescent phase to address proptosis. The purpose of this study is to analyze both clinical and imagiological outcomes of patients with TED who underwent orbital decompression. METHODS: A retrospective analysis of patients undergoing orbital decompression in Centro Hospitalar Universitário de Lisboa Central and Hospital Cuf Descobertas, between 2018 and 2021, was performed. Demographic and clinical data were collected. The procedures included lateral, inferior-medial, balanced (lateral and medial) and three-wall decompressions. Main clinical outcomes included best corrected visual acuity (BCVA), proptosis reduction and complications. A group of patients underwent orbital computed tomography (CT) scanning before and after surgery, and differences in globe displacement in the horizontal, vertical and anteroposterior planes were measured for each type of surgery. RESULTS: Forty-six orbits from 28 patients (18 females and 10 males) underwent decompression surgery. Mean age at time of surgery was 49.43 ± 11.63 years old. Orbital decompression was performed during the inactive phase in 19 patients (67.4%) and was required to treat sight-threatening active TED in 9 patients (32.6%). Lateral, inferior-medial, balanced and three-wall decompression were carried out in 12 (26.1%), 8 (17.4%), 14 (30.4%) and 12 (26.1%) orbits, respectively. From baseline, statistically significant improvements were observed after surgery in logMAR BCVA (p<0.05) and proptosis (p<0.001). Larger proptosis reduction occurred in three-wall decompression, followed by balanced decompression (p<0.001). New-onset strabismus occurred in 3 of the 28 patients (10.7%): 1 endoscopic inferior-medial decompression, 1 three-wall decompression with an endoscopic approach to the inferior and medial walls and 1 transorbital three-wall decompression. All the 3 cases presented DON non-reversible with high dose intravenous steroids. CONCLUSION: Orbital decompression is an effective procedure to address proptosis in TED, being also an important resource in cases of DON unresponsive to systemic steroids. The reduction in proptosis is associated with the number of orbital walls addressed. An individualized approach is crucial during surgical planning in TED cases. |
|---|---|
| Autores principais: | Guedes Mota, Catarina |
| Outros Autores: | Brandão, Pedro; Maleita, Diogo; Magriço, Ana; Duarte, Ana |
| Assunto: | Artigos Originais |
| Ano: | 2024 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Sociedade Portuguesa de Oftalmologia |
| Idioma: | inglês |
| Origem: | Revista Sociedade Portuguesa de Oftalmologia |
| _version_ | 1870266873508003840 |
|---|---|
| author | Guedes Mota, Catarina |
| author2 | Brandão, Pedro Maleita, Diogo Magriço, Ana Duarte, Ana |
| author2_role | author author author author |
| author_facet | Guedes Mota, Catarina Brandão, Pedro Maleita, Diogo Magriço, Ana Duarte, Ana |
| author_role | author |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Guedes Mota, Catarina\"},{\"Person.name\":\"Brandão, Pedro\"},{\"Person.name\":\"Maleita, Diogo\"},{\"Person.name\":\"Magriço, Ana\"},{\"Person.name\":\"Duarte, Ana\"}] |
| datacite.creators.creator.creatorName.fl_str_mv | Guedes Mota, Catarina Brandão, Pedro Maleita, Diogo Magriço, Ana Duarte, Ana |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Artigos Originais |
| datacite.titles.title.fl_str_mv | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis Cirurgia de Descompressão Orbitária na Orbitopatia Tiroideia: Análise Clínica e Imagiológica |
| dc.creator.none.fl_str_mv | Guedes Mota, Catarina Brandão, Pedro Maleita, Diogo Magriço, Ana Duarte, Ana |
| dc.description.none.fl_str_mv | INTRODUÇÃO: A descompressão cirúrgica da órbita é um procedimento amplamente utilizado no tratamento da orbitopatia tiroideia (OT). Está indicado tanto na fase ativa da doença, em casos de neuropatia ótica compressiva (NOC) ou de exposição corneana não reversíveis com corticoterapia sistémica, como na fase inativa para correção da proptose. O objetivo deste trabalho é analisar os resultados clínicos e imagiológicos de doentes com OT submetidos a cirurgia de descompressão orbitária. MÉTODOS: Avaliação retrospetiva de doentes submetidos a descompressão orbitária no Centro Hospitalar Universitário de Lisboa Central e no Hospital Cuf Descobertas, entre 2018 e 2021. Foram realizadas descompressões da parede lateral, ínfero-medial, balanceada (lateral-medial) e de três paredes. Resultados referentes à melhor acuidade visual corrigida (MAVC), redução da proptose e complicações pós-operatórias foram analisados. Um subgrupo de doentes foi submetido a tomografia computorizada (TC) das órbitas antes e depois da cirurgia, de forma a quantificar o deslocamento do globo ocular nos planos horizontal, vertical e ântero-posterior consoante o tipo de descompressão orbitária. RESULTADOS: Quarenta e seis órbitas, de 28 doentes, foram incluídas no estudo. A média de idades à data da cirurgia foi de 49,43 ± 11,63 anos. Nove doentes (32,6%) encontravam-se em fase ativa aquando da cirurgia e 19 (67,4%) foram intervencionados durante a fase inativa. Descompressões da parede lateral, ínfero-medial, balanceada e de três paredes foram realizadas em 12 (26,1%), 8 (17,4%), 14 (30,4%) e 12 (26,1%) órbitas, respetivamente. Após a cirurgia objetivou-se uma melhoria significativa na MAVC (p<0,05) e no grau de proptose (p<0,001). A redução mais acentuada da proptose foi observada na descompressão de três paredes, seguida da descompressão balanceada (p<0,001). Três doentes (10,7%) com NOC refratária a terapêutica médica no período pré-operatório desenvolveram estrabismo após a cirurgia. CONCLUSÃO: A descompressão cirúrgica da órbita é um procedimento eficaz na redução da proptose de doentes com OT e no tratamento de casos de NOC não responsiva a corticoterapia sistémica. O grau de redução da proptose está relacionado com o número de paredes abordadas. A abordagem individualizada de cada caso de OT é fundamental para a obtenção de bons resultados clínicos e imagiológicos. |
| dc.identifier.none.fl_str_mv | https://doi.org/10.48560/rspo.32537 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Ajnet |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | Artigos Originais |
| dc.title.fl_str_mv | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis Cirurgia de Descompressão Orbitária na Orbitopatia Tiroideia: Análise Clínica e Imagiológica |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | INTRODUCTION: Orbital decompression surgery has been widely used in thyroid eye disease (TED). It is performed in the active stage, in sight-threatening cases of dysthyroid compressive optic neuropathy (DON), or severe corneal exposure unresponsive to steroids, and also during the quiescent phase to address proptosis. The purpose of this study is to analyze both clinical and imagiological outcomes of patients with TED who underwent orbital decompression. METHODS: A retrospective analysis of patients undergoing orbital decompression in Centro Hospitalar Universitário de Lisboa Central and Hospital Cuf Descobertas, between 2018 and 2021, was performed. Demographic and clinical data were collected. The procedures included lateral, inferior-medial, balanced (lateral and medial) and three-wall decompressions. Main clinical outcomes included best corrected visual acuity (BCVA), proptosis reduction and complications. A group of patients underwent orbital computed tomography (CT) scanning before and after surgery, and differences in globe displacement in the horizontal, vertical and anteroposterior planes were measured for each type of surgery. RESULTS: Forty-six orbits from 28 patients (18 females and 10 males) underwent decompression surgery. Mean age at time of surgery was 49.43 ± 11.63 years old. Orbital decompression was performed during the inactive phase in 19 patients (67.4%) and was required to treat sight-threatening active TED in 9 patients (32.6%). Lateral, inferior-medial, balanced and three-wall decompression were carried out in 12 (26.1%), 8 (17.4%), 14 (30.4%) and 12 (26.1%) orbits, respectively. From baseline, statistically significant improvements were observed after surgery in logMAR BCVA (p<0.05) and proptosis (p<0.001). Larger proptosis reduction occurred in three-wall decompression, followed by balanced decompression (p<0.001). New-onset strabismus occurred in 3 of the 28 patients (10.7%): 1 endoscopic inferior-medial decompression, 1 three-wall decompression with an endoscopic approach to the inferior and medial walls and 1 transorbital three-wall decompression. All the 3 cases presented DON non-reversible with high dose intravenous steroids. CONCLUSION: Orbital decompression is an effective procedure to address proptosis in TED, being also an important resource in cases of DON unresponsive to systemic steroids. The reduction in proptosis is associated with the number of orbital walls addressed. An individualized approach is crucial during surgical planning in TED cases. |
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| identifier.doi.fl_str_mv | https://doi.org/10.48560/rspo.32537 |
| inst_facet_str | urn:organizationAcronym:spo{{{_:::_}}}Sociedade Portuguesa de Oftalmologia |
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| institution | Sociedade Portuguesa de Oftalmologia |
| instname_str | Sociedade Portuguesa de Oftalmologia |
| language | eng |
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| network_name_str | Revista Sociedade Portuguesa de Oftalmologia |
| oai_identifier_str | oai:ojs.revistas.rcaap.pt:article/32537 |
| organization_str_mv | urn:organizationAcronym:spo |
| person_str_mv | Guedes Mota, Catarina Brandão, Pedro Maleita, Diogo Magriço, Ana Duarte, Ana |
| publishDate | 2024 |
| publisher.none.fl_str_mv | Ajnet |
| repo_facet_str | urn:repositoryAcronym:oftalmo{{{_:::_}}}Revista Sociedade Portuguesa de Oftalmologia |
| reponame_str | Revista Sociedade Portuguesa de Oftalmologia |
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| spelling | AjnetenINTRODUCTION: Orbital decompression surgery has been widely used in thyroid eye disease (TED). It is performed in the active stage, in sight-threatening cases of dysthyroid compressive optic neuropathy (DON), or severe corneal exposure unresponsive to steroids, and also during the quiescent phase to address proptosis. The purpose of this study is to analyze both clinical and imagiological outcomes of patients with TED who underwent orbital decompression. METHODS: A retrospective analysis of patients undergoing orbital decompression in Centro Hospitalar Universitário de Lisboa Central and Hospital Cuf Descobertas, between 2018 and 2021, was performed. Demographic and clinical data were collected. The procedures included lateral, inferior-medial, balanced (lateral and medial) and three-wall decompressions. Main clinical outcomes included best corrected visual acuity (BCVA), proptosis reduction and complications. A group of patients underwent orbital computed tomography (CT) scanning before and after surgery, and differences in globe displacement in the horizontal, vertical and anteroposterior planes were measured for each type of surgery. RESULTS: Forty-six orbits from 28 patients (18 females and 10 males) underwent decompression surgery. Mean age at time of surgery was 49.43 ± 11.63 years old. Orbital decompression was performed during the inactive phase in 19 patients (67.4%) and was required to treat sight-threatening active TED in 9 patients (32.6%). Lateral, inferior-medial, balanced and three-wall decompression were carried out in 12 (26.1%), 8 (17.4%), 14 (30.4%) and 12 (26.1%) orbits, respectively. From baseline, statistically significant improvements were observed after surgery in logMAR BCVA (p<0.05) and proptosis (p<0.001). Larger proptosis reduction occurred in three-wall decompression, followed by balanced decompression (p<0.001). New-onset strabismus occurred in 3 of the 28 patients (10.7%): 1 endoscopic inferior-medial decompression, 1 three-wall decompression with an endoscopic approach to the inferior and medial walls and 1 transorbital three-wall decompression. All the 3 cases presented DON non-reversible with high dose intravenous steroids. CONCLUSION: Orbital decompression is an effective procedure to address proptosis in TED, being also an important resource in cases of DON unresponsive to systemic steroids. The reduction in proptosis is associated with the number of orbital walls addressed. An individualized approach is crucial during surgical planning in TED cases.ptINTRODUÇÃO: A descompressão cirúrgica da órbita é um procedimento amplamente utilizado no tratamento da orbitopatia tiroideia (OT). Está indicado tanto na fase ativa da doença, em casos de neuropatia ótica compressiva (NOC) ou de exposição corneana não reversíveis com corticoterapia sistémica, como na fase inativa para correção da proptose. O objetivo deste trabalho é analisar os resultados clínicos e imagiológicos de doentes com OT submetidos a cirurgia de descompressão orbitária. MÉTODOS: Avaliação retrospetiva de doentes submetidos a descompressão orbitária no Centro Hospitalar Universitário de Lisboa Central e no Hospital Cuf Descobertas, entre 2018 e 2021. Foram realizadas descompressões da parede lateral, ínfero-medial, balanceada (lateral-medial) e de três paredes. Resultados referentes à melhor acuidade visual corrigida (MAVC), redução da proptose e complicações pós-operatórias foram analisados. Um subgrupo de doentes foi submetido a tomografia computorizada (TC) das órbitas antes e depois da cirurgia, de forma a quantificar o deslocamento do globo ocular nos planos horizontal, vertical e ântero-posterior consoante o tipo de descompressão orbitária. RESULTADOS: Quarenta e seis órbitas, de 28 doentes, foram incluídas no estudo. A média de idades à data da cirurgia foi de 49,43 ± 11,63 anos. Nove doentes (32,6%) encontravam-se em fase ativa aquando da cirurgia e 19 (67,4%) foram intervencionados durante a fase inativa. Descompressões da parede lateral, ínfero-medial, balanceada e de três paredes foram realizadas em 12 (26,1%), 8 (17,4%), 14 (30,4%) e 12 (26,1%) órbitas, respetivamente. Após a cirurgia objetivou-se uma melhoria significativa na MAVC (p<0,05) e no grau de proptose (p<0,001). A redução mais acentuada da proptose foi observada na descompressão de três paredes, seguida da descompressão balanceada (p<0,001). Três doentes (10,7%) com NOC refratária a terapêutica médica no período pré-operatório desenvolveram estrabismo após a cirurgia. CONCLUSÃO: A descompressão cirúrgica da órbita é um procedimento eficaz na redução da proptose de doentes com OT e no tratamento de casos de NOC não responsiva a corticoterapia sistémica. O grau de redução da proptose está relacionado com o número de paredes abordadas. A abordagem individualizada de cada caso de OT é fundamental para a obtenção de bons resultados clínicos e imagiológicos.engenOutcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based AnalysisptCirurgia de Descompressão Orbitária na Orbitopatia Tiroideia: Análise Clínica e ImagiológicaTranslatedTitleGuedes Mota, CatarinaGuedes MotaCatarinaDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugalorcid0000-0003-4622-3296Brandão, PedroBrandãoPedroDepartment of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugalorcid0000-0002-3525-7645Maleita, DiogoMaleitaDiogoDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugalorcid0000-0002-1824-5714Magriço, AnaMagriçoAnaDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; Department of Ophthalmology, Hospital CUF Descobertas, Lisboa, Portugalorcid0009-0003-9594-4804Duarte, AnaDuarteAnaDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; Department of Ophthalmology, Hospital CUF Descobertas, Lisboa, Portugalorcid0000-0002-6426-7084EISSN3051-6579IsPartOf2024-06-29DOIhttps://doi.org/10.48560/rspo.32537http://purl.org/coar/access_right/c_abf2open accessArtigos Originaishttp://purl.org/coar/resource_type/c_6501journal articlehttps://creativecommons.org/licenses/by-nc/4.02024-06-29fulltextapplication/pdfRevista Sociedade Portuguesa de Oftalmologia4828192 |
| spellingShingle | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis Guedes Mota, Catarina Artigos Originais |
| status | SINGLETON |
| subject.fl_str_mv | Artigos Originais |
| title | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis |
| title_full | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis |
| title_fullStr | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis |
| title_full_unstemmed | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis |
| title_short | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis |
| title_sort | Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease: Clinical and Computed Tomography-Based Analysis |
| topic | Artigos Originais |
| topic_facet | Artigos Originais |
| url | https://doi.org/10.48560/rspo.32537 |
| visible | 1 |