Área Técnica: Órbita
Customized Orbital Decompression Surgery predictably improves lower eyelid retraction and contour in Thyroid Eye Disease
To assess the hypothesis that a customized approach with targeted zygomatic basin bone removal to orbital decompression surgery predictably improves lower eyelid retraction and eyelid contour in Thyroid Eye Disease.
In a retrospective, consecutive study, clinical charts and photos before and after orbital decompression were reviewed. Exophthalmometry was recorded as well the type of decompression performed.All photos were taken with a standardized technique. Midpupil to lower eyelid margin distances (MRD2s) at 11 meridians and the globe position relative to the medial canthus were measured with the assistance of customized software. The difference between pre- and post- operative MRD2s and between vertical globe positions was calculated. Each eyelid was labeled as within or outside normal limits regarding both contour pattern analysis and MRD2 at 90° compared to the a control normal range.
A total of 105 orbits from 57 patients met the inclusion criteria for the study. Ninety-eight orbits had lateral orbital wall decompression and in 53% of these cases, bone in the zygomatic basin was also removed. Eyelid contour and globe position from patients with orbital decompression with zygomatic basin removal and without were compared. Removal of the zygomatic basin did not decrease proptosis in either group, but significantly induced vertical globe descent and improved reduction in MRD2 (p<0.05).
The findings in our study support the practical utility of incorporating a customized approach to orbital decompression, and suggest that an individualized approach with targeted bone removal may obviate the need for additional surgeries such as lower eyelid retraction repair.