| Reduction of diplopia following endoscopic orbital decompression: the orbital sling technique. | |
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MedLine Citation:
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PMID: 12368609 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Although endoscopic orbital decompression has become the surgical treatment of choice for patients with proptosis from Graves disease, postoperative diplopia requiring corrective eye muscle surgery can occur in up to 63% of patients. The purpose of the study was to evaluate a new technique intended to reduce the incidence of diplopia following endoscopic orbital decompression. STUDY DESIGN: Case-control. METHODS: Endoscopic orbital decompression was performed on 58 orbits in 37 patients with proptosis from Graves disease. The orbital sling technique, which makes use of a horizontal strip of periorbital fascia to prevent prolapse of the medial rectus muscle, was used on 20 orbits in 13 patients. Conventional endoscopic decompression was performed in 24 control subjects. The mean duration of follow-up was 3.3 +/- 1.3 years (range, 1.7-5.1 y). RESULTS: The incidence of new-onset or worsened diplopia following endoscopic decompression was significantly lower for the orbital sling group compared with control subjects (0% vs. 29.2%, respectively [ =.038]). No patients in the orbital sling group developed new-onset diplopia following surgery. Of the eight patients with pre-existing diplopia from the orbitopathy, double vision improved in four patients (50%) and was unchanged in the remaining four patients (50%). The mean reduction in proptosis was comparable for the orbital sling and control groups (5.1 +/- 1.1 mm vs. 5.0 +/- 1.9 mm, respectively [ P=.98]). CONCLUSIONS The preservation of a fascial sling overlying the medial rectus muscle during endoscopic orbital decompression appears to reduce the incidence of postoperative diplopia, while still allowing for a satisfactory reduction in proptosis. This modification of the standard decompression technique should be considered for the treatment of patients with proptosis. |
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Authors:
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Ralph Metson; Mark Samaha |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Laryngoscope Volume: 112 ISSN: 0023-852X ISO Abbreviation: Laryngoscope Publication Date: 2002 Oct |
Date Detail:
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Created Date: 2002-10-07 Completed Date: 2002-10-24 Revised Date: 2005-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8607378 Medline TA: Laryngoscope Country: United States |
Other Details:
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Languages: eng Pagination: 1753-7 Citation Subset: IM |
Affiliation:
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Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Ralph_Metson@meei.harvard.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Decompression, Surgical / adverse effects, methods* Diplopia / etiology, prevention & control* Endoscopy* / adverse effects, methods Exophthalmos / etiology, surgery* Fascia / surgery Female Graves Disease / complications Humans Male Middle Aged Orbit / surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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