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

TL;DR

This study shows that endoscopic medial wall surgery effectively reduces eye bulging in Graves’ ophthalmopathy with minimal complications.

Contribution

The paper presents a single-center follow-up analysis of endoscopic medial wall decompression for Graves’ ophthalmopathy.

Findings

Endoscopic medial wall decompression significantly reduced proptosis by an average of 3.39 mm.

Most surgeries were performed for proptosis, not optic neuropathy.

No long-term complications were reported in the follow-up period.

Abstract

To examine the success rate of endoscopic decompression surgery in Graves’ ophthalmopathy.

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.

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.

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.

Figures