Purpose

To evaluate proptosis reduction after image-guided deep lateral orbital decompression using the Sonopet ultrasonic aspirator in patients with thyroid-associated orbitopathy.

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Methods

In this retrospective 6-month case series, 55 patients, comprising 80 orbits, underwent image-guided deep lateral orbital decompression with the ultrasonic aspirator Sonopet; 25 patients (45%) had bilateral surgery. Mean age was 51.1 ± 11.9 years (range, 26-74). Proptosis reduction was assessed by Hertel exophthalmometry at 3 and 6 months. Secondary outcomes included new-onset diplopia and sensory disturbances in the zygomatic and infraorbital nerve (V2) distributions.

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Results

Mean proptosis decreased from 23.5 ± 2.8 mm preoperatively (range, 18-31 mm) to 18.5 ± 2.5 mm postoperatively (range, 14-25 mm). Mean reduction was 4.91 mm at 3 months (95% CI, 4.60-5.22; p < 0.001) and 4.79 mm at 6 months (95% CI, 4.47-5.10; p < 0.001). The difference between 3 and 6 months was not significant (mean difference, -0.13 mm; p = 0.183), indicating a stable effect. Higher preoperative Hertel values were moderately correlated with greater proptosis reduction at 3 months (r = 0.44; p < 0.001) and 6 months (r = 0.39; p < 0.001). Complications included new-onset diplopia in 4 patients (7%), zygomatic hypoesthesia in 17 (31%), and V2 hypoesthesia in 4 (7%); most improved during follow-up.

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Conclusion

Image-guided deep lateral orbital decompression using the ultrasonic aspirator appears to be an effective and safe surgical approach for patients with thyroid-associated orbitopathy. The procedure achieved a substantial and stable reduction in proptosis at 6 months, with a mean reduction of 4.8 ± 1.2 mm and a range of 3.0 to 9.0 mm. This reduction compares favorably with previously reported values of 2.7 to 4.0 mm.

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Additional Authors

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