ePoster listing and sessions

Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London

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Endoscopic Orbital Decompression via Transcaruncular Approach for Compressive Optic Neuropathy Secondary to Thyroid Eye Disease, a Case Report

Author: Alexander Gerard Gungab
ePoster Number: 294


Purpose

To demonstrate the advantages and surgical outcomes of endoscopic orbital decompression via transcaruncular approach for compressive optic neuropathy secondary to thyroid eye disease.


Methods

This is a case of a 61-year-old male, known hyperthyroid, who underwent endoscopic bony decompression of the right orbital apex via transcaruncular approach with removal of the posteromedial ethmoid and posteromedial inferior orbital walls. Patient presented with a 1-month history of progressive blurring of vision, right with moderate proptosis. On orbital CT scan, there is enlargement of the medial and inferior recti muscles. Computerized visual field analysis pre-operatively revealed generalized depression of the right eye. Main outcome measures were improvement in visual acuity and visual field, reduction of proptosis and no post-operative diplopia.


Results

Pre-operative visual acuity of the right eye was at 20/400 improved to 20/40 with improvement in Ishihara color vision test score 29 days post-operatively. Computerized visual field analysis showed marked improvement of the generalized visual field defect. The proptosis of the right eye had decreased from 19mm to 16mm. The was no post-operative diplopia. No instances of nasolacrimal duct injury and post-operative hemorrhage were noted. Orbital CT scan post operatively revealed no inferomedial shift of orbital structures. There is prolapse of fat into the posteromedial inferior and posteromedial (ethmoid) wall of the orbit, right.


Conclusion

Endoscopic decompression via transcaruncular approach was successful in treatment of compressive optic neuropathy secondary to thyroid-associated orbitopathy. The access leaves no external scar or disruption of the medial canthus. Decompression of the orbital apex including the ethmoid posteromedial wall and posteromedial inferior orbital wall spares the anteromedial and anteroinferior orbital wall that are typically removed in a standard inferomedial decompression. The use of an endoscope empowers the surgeon for better anatomical and surgical view.


Additional Authors

First nameLast nameBase Hospital / Institution
ReynaldoJavate, MDUniversity of Santo Tomas Hospital Eye Institute, Manila, Philippines

Abstract ID: 21-202