ABSTRACT
AIM: To investigate the effect of orbital decompression on the central macular choroidal thickness(CMCT)in patients with thyroid-associated ophthalmopathy(TAO).METHOD: Prospective clinical studies. A total of 29 TAO patients(42 eyes)treated in our department from January 2021 to January 2022 were analyzed, and they were divided into 20 cases(30 eyes)in the moderate and severe group and 9 cases(12 eyes)in the extremely severe group. Both groups of patients received orbital decompression, and the changes of CMCT, visual acuity, intraocular pressure, exophthalmos, and clinical activity score(CAS)at 3 and 6mo before and after surgery were compared between the two groups.RESULTS: All patients completed follow-up. The CMCT, exophthalmos, intraocular pressure, and CAS of the extremely severe group at 3 and 6mo were 355.13±15.59 and 339.61±13.17μm, 19.33±2.23 and 17.83±1.70mm, 18.86±3.05 and 18.09±1.37mmHg, 3.75±0.87 and 2.42±1.00 points, respectively. The moderate and severe group was 325.00±10.48 and 321.04±11.34μm, 16.07±1.74 and 15.6±1.98mm, 16.65±2.04 and 16.03±2.3mmHg, 1.50±0.51 and 1.43±0.50 points, and there was differences with those before operation(extremely severe group: 396.46±17.61μm, 22.00±2.3mm, 21.85±2.82mmHg, 5.33±1.44 points; moderate and severe group: 335.77±11.60μm, 19.07±1.84mm, 18.89±3.06mmHg, 1.63±0.49 points; all P<0.001). The best corrected visual acuity(LogMAR)before surgery was 0.64±0.22 in the extremely severe group, and 0.43±0.20 and 0.34±0.15 at 3 and 6mo after operation, respectively, which were different from those before surgery(all P<0.001)CONCLUSION: Orbital decompression can effectively reduce CMCT, intraocular pressure and exophthalmos in TAO patients, relieve orbital vein stasis, and effectively improve vision and reduce mobility in patients with extremely severe disease.
ABSTRACT
@#AIM: To explore the clinical effect and safety of deep lateral wall combined with medial wall orbital decompression in the treatment of thyroid associated ophthalmopathy(TAO).<p>METHODS: Totally 17 patients with TAO in our department from January 2019 to May 2020 were included. All patients underwent deep lateral wall combined with medial wall orbital decompression under general anesthesia, the visual acuity, recovery of exposure keratitis, exophthalmos, intraocular pressure and complications were compared before and after operation.<p>RESULTS: Eight patients(9 eyes)with TAO and dysthyroid optic neuropathy(DON)were included in the study. The best corrected visual acuity averaged 0.78±0.15 preoperatively and 0.36±0.12 1mo postoperatively, which was statistically significant(<i>P</i><0.01)compared with the preoperative visual acuity, 0.38±0.12 at 6mo after surgery, which was not statistically different from that at 1mo after surgery(<i>P</i>=0.594). The mean preoperative proptosis was 23.75±2.55mm and the mean postoperative proptosis was 14.85±1.53mm at 1mo, which was statistically significant compared with the preoperative proptosis(<i>P</i><0.01), proptosis was on average 14.60±1.64mm at 6mo after surgery and remained generally stable(<i>P</i>=0.658)from 1mo before surgery. The intraocular pressure of the patients was 25.56±3.23mmHg preoperatively and 18.42±2.35mmHg 1mo postoperatively, which was statistically significant compared with the preoperative value(<i>P</i><0.01), and the intraocular pressure of the patients was reduced to 15.82±2.57mmHg at the 6mo postoperative follow-up, which was statistically significant compared with the intraocular pressure of the patients 1mo postoperatively(<i>P</i><0.01). There were 6 eyes of 6 patients with exposure keratitis preoperatively, 4 eyes improved and 2 eyes were cured in the 1mo postoperative, and all 6 eyes were cured 6mo postoperatively. Postoperatively, the diplopia of the patients all decreased to various degrees, and there were some patients whose diplopia symptoms continued to improve 6mo thereafter without other serious complications.<p>CONCLUSION: Deep lateral wall combined with medial wall orbital decompression can effectively improve the proptosis and also have a good effect on severe complications such as DON and exposure keratitis with few complications, so deep lateral wall combined with medial wall orbital decompression is an effective surgical procedure in the treatment of severe TAO.