Abstract ID: 26-264
Surgical Outcomes of Single-Stage Orbital Decompression and Inferior Rectus Recession in Moderate-to-Severe Thyroid Eye Disease
Author: Eduardo Bianchi Base Hospital / Institution: Section of Ophthalmology, Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.
Presentation Type: ePoster Presentation
Purpose
To evaluate the safety and efficacy of single-stage orbital decompression combined with inferior rectus recession in patients with moderate-to-severe thyroid eye disease (TED) and restrictive vertical strabismus.
Methods
Retrospective case series of 32 consecutive patients treated between 2017 and 2025; 68% were female. Mean follow-up was 2.4 ± 1.4 years. All patients underwent combined surgery in a single operative session, consisting of endoscopic medial wall decompression followed by inferior rectus recession for restrictive hypotropia. When indicated, lateral wall decompression was performed after strabismus surgery during the same session. Inferior rectus recession was guided by intraoperative forced duction testing and performed using the relaxed intraoperative muscle positioning technique. Primary outcome measures were diplopia in primary and reading position, ocular alignment, proptosis reduction, need for additional surgery, and complications.
Results
Combined surgery produced a significant reduction in proptosis and a statistically significant improvement in diplopia on paired analysis (McNemar and Wilcoxon signed-rank tests, p < 0.05), with expansion of the binocular single vision field in most patients. Postoperatively, 23 patients were orthophoric, 6 required a small prism correction for reading, and only 3 required prism correction in primary position, supporting good functional alignment in the principal positions of gaze. This approach enabled effective correction of restrictive vertical deviation within a single rehabilitative phase. Residual or induced horizontal deviations, when present, were managed secondarily in selected cases.
Conclusion
Single-stage orbital decompression combined with inferior rectus recession is a safe and functionally effective strategy in selected TED patients, providing proptosis reduction and improvement in binocular alignment while minimizing the need for staged procedures. These findings support its role as an alternative to conventional staged management.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Flavia | Quaranta Leoni | Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; flavia.quarantaleoni@ptvonline.it |
| Raffaello | Romeo | ENT Department, Villa Tiberia Hospital – GVM Care & Research, Rome, Italy |
| Francesco | Quaranta Leoni | Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; francescomaria.quarantaleoni@unife.it – Orbital and Adnexal Service, Tiberia Hospital, GVM Care & Research, 00137 Rome, Italy |