ABSTRACT
RESUMEN La orbitopatía tiroidea es una enfermedad autoinmune, en la que una reacción inflamatoria genera aumento de la presión orbitaria con protrusión de su contenido. A menudo es autolimitada y sus síntomas más frecuentes son retracción palpebral, exoftalmo y diplopía. Existen casos severos con compromiso de la agudeza visual por compresión del nervio óptico. El diagnóstico es clínico, pero debe complementarse con una tomografía computarizada. Su tratamiento depende de la gravedad y actividad de la enfermedad, siendo los procedimientos quirúrgicos, como la descompresión orbitaria, de elección en exoftalmo y neuropatía óptica compresiva. El pilar de tratamiento en la orbitopatía tiroidea severa es la cirugía descompresiva. Se han descrito múltiples técnicas, pero con limitaciones. La descompresión endoscópica transnasal, es considerada actualmente el procedimiento de elección, ya que permite una buena visualización de la pared medial, con resultados comparables y menores complicaciones, respecto a métodos tradicionales. Describimos un caso de oftalmopatía tiroidea severa, con exoftalmo, diplopía y disminución de la agudeza visual, en la que se realizó una descompresión endoscópica con muy buenos resultados.
ABSTRACT Thyroid orbitopathy is an autoimmune disease in which an inflammatory reaction generates increased orbital pressure with protrusion of its contents. It is often self-limiting and its most frequent symptoms are eyelid retraction, exophthalmos and diplopia. There are severe cases with compromised visual acuity due to compression of the optic nerve. The diagnosis is clinical, but must be complemented with a computed tomography scan. Its treatment depends on the severity and activity of the disease and the surgicals procedures such as orbital decompression is the best choice in exophthalmos and compressive optic neuropathy. The treatment in severe thyroid orbitopathy is decompressive surgery. Multiple techniques have been described, but with limitations. The transnasal endoscopic decompression is currently considered the gold standard, since it allows a good visualization of the medial wall with comparable results and less complications, compared to traditional methods. We present a case of severe thyroid ophthalmopathy, with exophthalmos, diplopia and decreased visual acuity, in which a transnasal endoscopic decompression was performed with very good outcomes.
Subject(s)
Humans , Female , Adult , Orbit/surgery , Graves Disease/surgery , Decompression, Surgical/methods , Endoscopy , Tomography, X-Ray Computed , Optic Nerve DiseasesABSTRACT
INTRODUCCIÓN: La orbitopatía tiroidea es una de las manifestaciones extratiroideas más frecuentes de la enfermedad de graves. El diagnóstico es clínico y con estudios de imágenes. El tratamiento depende de la etapa en que se encuentre la enfermedad, pudiendo ser conservador o quirúrgico, siendo la descompresión orbitaria el pilar del tratamiento. OBJETIVOS: Describir la técnica quirúrgica y las complicaciones más frecuentes. Comprobar los beneficios en la reducción del exoftalmos, la mejoría de la agudeza visual y la descompresión del nervio óptico...
INTRODUCTION: Thyroid orbitopathy is one of the most frequent extra thyroid manifestations of Graves' disease. The diagnosis is clinical and with imaging studies. The treatment depends on the stage in which the disease is found; can be conservative or surgical, the orbital decompression is the pillar of the treatment. OBJECTIVES: Describe the surgical technique and the most frequent complications checking the benefits in the reduction of exophthalmos, the improvement of visual acuity and decompression of the optic nerve
INTRODUÇÃO: A orbitopatia tireoidiana é uma das manifestações extra tireóides mais freqüentes da doença de graves. O diagnóstico é clínico e com estudos de imagem. O tratamento depende da fase em que a doença é encontrada; podendo ser conservador ou cirúrgico, sendo a descompressão orbital o pilar do tratamento. OBJETIVOS: Descreva a técnica cirúrgica e as complicações mais frequentes. Verificar os benefícios na redução do exoftalmos, a melhora da acuidade visual e descompressão do nervo óptico...
Subject(s)
Humans , Male , Adult , Decompression, Surgical/methods , Graves Ophthalmopathy/surgery , Retrospective Studies , Graves Ophthalmopathy/complications , Natural Orifice Endoscopic Surgery/methodsABSTRACT
Since 1957, when Walsh and Ogura introduced transantral orbital decompression, various surgical approaches have been introduced for the treatment of dysthyroid orbitopathy. With the development of endoscopic sinus surgery, orbital decompression can now be approached transnasally by endoscope alone. We reviewed the medical records of 10 patients who had received endoscopic orbital decompression. Of the 10 patients, four eyes from three patients were managed for decreased visual acuity, while 13 eyes from seven patients were managed for exophthalmos. Three patients who had initially complained of decreased vision demonstrated eventual improvement. An initial mean proptosis of 19.3 mm decreased to 16.5 mm. Six eyes with abnormal color vision were resolved after the decompression. Four patients with diplopia complained of continued diplopia after the decompression and were managed with extraocular muscle surgery or prism glasses. Compared to the conventional transantral approach, endoscopic orbital decompression features less morbidity and comparable ophthalmic results.
Subject(s)
Humans , Color Vision , Decompression , Diplopia , Endoscopes , Exophthalmos , Eyeglasses , Glass , Medical Records , Orbit , Visual AcuityABSTRACT
Many techniques have been employed for the treatment of dysthyroid optic neuropathy. With the development of intranasal endoscopic skills, endoscopic orbital decompression is now performed as one of surgical treatments of the disease. Orbital decompression was performed by endoscopic approach on 3 orbits in 2 patients. Proptosis was reduced 3 mm each in 2 orbits of a patient by Hertel measurement and visual acuity was improved in both patients. The endonasal endoscopic approach provided visual improvement without the morbidity of the traditional Walsh-Ogura method.