Efficacy and complications of orbital fat decompression in Graves' orbitopathy: a systematic review and meta-analysis.

In Graves' orbitopathy, surgical decompression is often needed for functional and aesthetic reasons. This meta-analysis was performed to assess the efficacy and safety of fat removal orbital decompression (FROD) alone to treat exophthalmos in Graves' orbitopathy. A systematic search was conducted in PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published before August 2018. Random-effects meta-analyses were applied; weighted means and weighted proportions with corresponding 95% confidence intervals (CI) were calculated. Study quality and quality of evidence for each individual outcome were analyzed. Of 1908 records initially identified, 13 observational studies were selected, representing 4820 orbits in 2514 patients. Weighted Hertel exophthalmometry was 23.10mm (95% CI 21.77-24.43mm) preoperative and 19.31mm (95% CI 17.81-20.81mm) postoperative. The weighted mean difference was 3.81mm (95% CI 3.41-4.21mm). Five studies reported an improvement of diplopia after surgery, occurring in 943 of 1172 patients (weighted proportion 0.50, 95% CI 0.15-0.85). Persistent new onset diplopia was reported in five studies, or 124 of 1277 patients (weighted proportion 0.15, 95% CI 0.03-0.27). No serious adverse events were reported. Results support the effectiveness and safety of FROD to treat mild-to-moderate exophthalmos in Graves' orbitopathy. Prospective and controlled trials are needed to improve the level of evidence.

Male subfertility: communication, care, coping. An explorative study.

AIM OF THE STUDY: With this study, we wanted to examine the needs of men with fertility problems in terms of communication, care and coping with the diagnosis. METHODOLOGY: data gathered prospectively by means of a written questionnaire (quantitative data), and semi-structured interviews (qualitative data). SAMPLE: 78 subfertile men who consulted for subfertility at the department for reproductive medicine at the University Hospital of Ghent, Belgium were included in the assessment; of these, 23 were interviewed for qualitative evaluation. RESULTS AND CONCLUSIONS: More than one fifth of the participants was dissatisfied with the way they had been informed about their fertility status. There was no significant difference in satisfaction with the care received immediately after diagnosis whether it was given by a general practitioner or by a specialist. A significant influence of nationality was noted on the satisfaction about being informed, Dutch men being much less satisfied than Flemish men. Some men suggested to have a consult with the doctor on a structural basis about a week after the diagnosis. The internet seemed to be a good medium for obtaining medical information IT COULD BE USEFUL TO CREATE AN EXTRA FUNCTION: a 'coach' supporting the couple throughout the entire process., adding another argument to the need for professional psychological support of patients attending clinics for human reproduction. The subfertile men often felt that they were watching from the sideline, and wanted to be more actively involved in the treatment.