Microscopic Deep Orbital Fat Decompression for Thyroid Eye Disease
Author: Tomoyuki Kashima
Base Hospital / Institution: Oculofacial Clinic Group
Rapid fire oral presentation
Abstract ID: 24-479
Purpose
Exophthalmos caused by thyroid eye disease is normally treated by orbital decompression, which involves orbital fat and bone resection. In this study, we investigated how the fusion image area (FIA) changes after orbital decompression surgery, which mainly involves microscopic resection of the orbital fat inside and outside the muscle cone, using the binocular single vision (BSV) test.
Methods
Included were 203 patients (406 eyes) with thyroid eye disease who underwent bilateral orbital fat decompression at our group between January and December 2021. Patient age and sex, postoperative changes in Hertel exophthalmometer measurements, amount of orbital fat removed and BSV were recorded. The FIA was defined as the average of the four locations (up, down, right, and left gaze) from the primary position at which diplopia was felt, which were determined using the BSV test. The FIA was determined preoperatively and at 1, 3, and 6 months postoperatively, and of the 203 patients, changes in the FIA were investigated in 75 patients who could be followed up to 6 months postoperatively.
Results
The 203 patients (163 women, 40 men) had a mean age of 40.0±12.7 years (range, 15–65 years). The mean ocular protrusion decreased from 19.8±2.9 mm preoperatively to 16.7±2.5 mm postoperatively. The average amount of fat removed was 3.5±1.5 ml. The FIA decreased from 44.5±12.9 degrees preoperatively to 44.3±11.9 (p=0.768), 44.1±12.5 (p=0.567), and 44.5±11.8 degrees (p=0.977) at 1, 3, and 6 months, respectively, after surgery. At 6 months postoperatively, no patient exhibited NOD in the first eye position.
Postoperatively, 25 of 406 eyes (6.16%) had mild mydriasis while none had complete mydriasis, and 2 eyes (0.5%) still had very mild mydriasis at 3 months postoperatively.
Conclusion
Microscopic deep orbital fat decompression is a safe procedure that is less likely to cause visual dysfunction than existing techniques, suggesting that this technique could be the first choice for surgical treatment of thyroid eye disease.
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