Research Fellow Thomas Jefferson University Hospital Philadelphia, Pennsylvania
Introduction: Thyroid eye disease (TED) can result in intractable adnexal and orbital changes requiring surgical orbital decompression (OD). Both TED and OD are associated with an increased risk of new-onset postoperative (NOP) diplopia. A lower incidence of NOP diplopia has been hypothesized with a “balanced” OD of the medial and lateral orbital walls; however, lateral OD may be associated with higher perioperative risk. In this study, we investigate the incidence of NOP diplopia at an institution that utilizes an endoscopic transnasal medial orbital wall and transconjunctival inferior wall OD with preservation of the maxillary strut.
Methods: This is a retrospective chart review of patients with TED who underwent a combined medial and inferior wall OD between 2010-2020 at a single tertiary care institution.
Results: Results were obtained from 83 patients (59 females) with a mean age of 55 years. Eighty-three patients (138 orbits) underwent OD, with approximately equal number undergoing unilateral OD (n=43) as bilateral OD (n=40). Most patients reported preoperative diplopia (n=60, 75.9%). Seven of the 19 patients without preoperative diplopia underwent a bilateral OD. Few patients (2/19; 10.5%) developed NOP diplopia. One patient had mild, intermittent diplopia. The other patient had experienced TED progression and diplopia but was successfully treated with prism glasses. No patients suffered from iatrogenic perioperative complications.
Conclusion: A combined endoscopic medial and transconjunctival inferior orbital wall decompression was associated with a low incidence of NOP diplopia in patients without preoperative diplopia, which suggests that the purported “balancing” advantage of lateral OD may not be valid.