| Transconjunctival orbital decompression in Graves' ophthalmopathy: lateral wall approach ab interno. | |
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MedLine Citation:
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PMID: 10873993 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: A modified surgical technique is described to perform a one, two, or three wall orbital decompression in patients with Graves' ophthalmopathy. METHODS: The lateral wall was approached ab interno through a "swinging eyelid" approach (lateral canthotomy and lower fornix incision) and an extended periosteum incision along the inferior and lateral orbital margin. In addition, the orbital floor and medial wall were removed when indicated. To minimise the incidence of iatrogenic diplopia, the lateral and medial walls were used as the first surfaces of decompression, leaving the "medial orbital strut" intact. During 1998, this technique was used in a consecutive series of 19 patients (35 orbits) with compressive optic neuropathy (six patients), severe exposure keratopathy (one patient), or disfiguring/congestive Graves' ophthalmopathy (12 patients). RESULTS: The preoperative Hertel value (35 eyes) was on average 25 mm (range 19-31 mm). The mean proptosis reduction at 2 months after surgery was 5.5 mm (range 3-7 mm). Of the total group of 19 patients, iatrogenic diplopia occurred in two (12.5%) of 16 patients who had no preoperative diplopia or only when tired. The three other patients with continuous preoperative diplopia showed no improvement of double vision after orbital decompression, even when the ocular motility (ductions) had improved. In the total group, there was no significant change of ductions in any direction at 2 months after surgery. All six patients with recent onset compressive optic neuropathy showed improvement of visual acuity after surgery. No visual deterioration related to surgery was observed in this study. A high satisfaction score (mean 8.2 on a scale of 1 to 10) was noted following the operation. CONCLUSION: This versatile procedure is safe and efficacious, patient and cost friendly. Advantages are the low incidence of induced diplopia and periorbital hypaesthesia, the hidden and small incision, the minimal surgical trauma to the temporalis muscle, and fast patient recovery. The main disadvantage is the limited exposure of the posterior medial and lateral wall. |
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Authors:
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D A Paridaens; K Verhoeff; D Bouwens; W A van Den Bosch |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The British journal of ophthalmology Volume: 84 ISSN: 0007-1161 ISO Abbreviation: Br J Ophthalmol Publication Date: 2000 Jul |
Date Detail:
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Created Date: 2000-10-06 Completed Date: 2000-10-06 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 0421041 Medline TA: Br J Ophthalmol Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 775-81 Citation Subset: IM |
Affiliation:
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Rotterdam Eye Hospital, Department of Oculoplastic and Orbital Surgery, Rotterdam, The Netherlands. paridaens@ned.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Decompression, Surgical / methods* Diplopia / surgery Female Graves Disease / surgery* Humans Keratitis / surgery Male Middle Aged Optic Nerve Diseases / surgery Patient Satisfaction Treatment Outcome Visual Acuity |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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