Top

International Ophthalmology

Published in:

01-12-2024 | Diplopia | Review

A meta-analysis of the efficacy of two-wall orbital decompression operations for thyroid-associated ophthalmopathy

Authors: Yu Jinhai, Chen Yunxiu, Xiong Chao, Wang Yaohua, Yuan Kai, Liao Hongfei

Published in: International Ophthalmology | Issue 1/2024

Abstract

Background

The main treatment for the symptoms of proptosis and optic nerve compression caused by thyroid-associated ophthalmopathy is orbital decompression surgery. Medial inferior wall decompression and balanced decompression are two frequently used surgical procedures. However, there is no unified consensus on how to choose different surgical options for orbital decompression in clinical practice.

Aims

To compare the effects of medial inferior wall decompression and balanced decompression surgery through meta-analysis and to provide reference for clinical optimal decision making.

Methods

Databases, including PubMed, Web of Science, Ovid, Cochrane Library, and ClinicalTrials.gov, were searched for randomized controlled trials and cohort studies on decompression surgery for thyroid-associated ophthalmopathy published from inception to March 21, 2023. Using RevMan 5.3 software, a meta-analysis was conducted based on the following outcome indicators: proptosis, diplopia rate, intraocular pressure, visual acuity, and complication rate.

Results

Two randomized controlled trials and five cohort studies with a total of 377 patients were included in this analysis. After balanced decompression surgery, patients with thyroid-associated ophthalmopathy experienced a significant decrease in proptosis [MD = 4.92, 95% CI (4.26, 5.58), P < 0.0001]. Balanced decompression can improve postoperative visual acuity [MD = − 0.35, 95% CI (− 0.56, − 0.13), P = 0.001] and intraocular pressure [MD = 5.33, 95% CI (3.34, 7.32), P < 0.0001]. The rates of proptosis [MD = 0.33, 95% CI (− 1.80, 2.46), P = 0.76] and diplopia [OR = 1.20, 95% CI (0.38, 3.76), P = 0.76] did not differ between patients who underwent medial inferior wall decompression and those who underwent balanced decompression.

Conclusion

Balanced decompression and medial inferior wall decompression are both effective options for surgical treatment of thyroid-associated ophthalmopathy in clinical practice.

Available only for authorised users

Li Z, Cestari DM, Fortin E (2018) Thyroid eye disease: What is new to know? Curr Opin Ophthalmol 29(6):528–534. https://doi.org/10.1097/ICU.0000000000000529CrossRefPubMed

Cockerham KP, Padnick-Silver L, Stuertz N et al (2021) Quality of life in patients with chronic thyroid eye disease in the United States. Ophthalmol Ther 10(4):975–987. https://doi.org/10.1007/s40123-021-00385-8CrossRefPubMedPubMedCentral

Bartalena L, Kahaly GJ, Baldeschi L et al (2021) The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy. Eur J Endocrinol 185(4):G43–G67. https://doi.org/10.1530/EJE-21-0479CrossRefPubMed

Poslednik KB, Czerwaty K, Ludwig N et al (2022) Treatment results of endoscopic transnasal orbital decompression for Graves’ orbitopathy-a single-center retrospective analysis in 28 orbits of 16 patients. J Pers Med. https://doi.org/10.3390/jpm12101714CrossRefPubMedPubMedCentral

Parrilla C, Mele DA, Gelli S et al (2021) Multidisciplinary approach to orbital decompression. A review. Acta Otorhinolaryngol Ital 41(Suppl. 1):S90–S101. https://doi.org/10.14639/0392-100X-suppl.1-41-2021-09CrossRefPubMedPubMedCentral

Unal M, Ileri F, Konuk O et al (2003) Balanced orbital decompression combined with fat removal in Graves ophthalmopathy - Do we really need to remove the third wall? Ophthalmic Plast Reconstr Surg 19(2):112–118. https://doi.org/10.1097/01.IOP.0000056145.71641.F5CrossRefPubMed

Korkmaz S, Konuk O (2016) Surgical treatment of dysthyroid optic neuropathy: long-term visual outcomes with comparison of 2-wall versus 3-wall orbital decompression. Curr Eye Res 41(2):159–164. https://doi.org/10.3109/02713683.2015.1008641CrossRefPubMed

West M, Stranc M (1997) Long-term results of four-wall orbital decompression for Graves’ ophthalmopathy. Br J Plast Surg 50(7):507–516. https://doi.org/10.1016/s0007-1226(97)91299-6CrossRefPubMed

DeParis SW, Tian J, Rajaii F (2019) Practice patterns in orbital decompression surgery among American Society of Ophthalmic Plastic and Reconstructive Surgery members. Ophthalmol Ther 8(4):541–548. https://doi.org/10.1007/s40123-019-00206-zCrossRefPubMedPubMedCentral

10.

Yao WC, Sedaghat AR, Yadav P et al (2016) Orbital decompression in the endoscopic age: the modified inferomedial orbital strut. Otolaryngol Head Neck Surg 154(5):963–969. https://doi.org/10.1177/0194599816630722CrossRefPubMed

11.

Cubuk MO, Konuk O, Unal M (2018) Orbital decompression surgery for the treatment of Graves’ ophthalmopathy: comparison of different techniques and long-term results. Int J Ophthalmol 11(8):1363–1370. https://doi.org/10.18240/ijo.2018.08.18CrossRefPubMedPubMedCentral

12.

Goldberg RA, Perry JD, Hortaleza V et al (2000) Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy. Ophthalmic Plast Reconstr Surg 16(4):271–277. https://doi.org/10.1097/00002341-200007000-00004CrossRefPubMed

13.

Pereira TS, Leite CA, Kuniyoshi CH et al (2022) A randomized comparative study of inferomedial vs. balanced orbital decompression. Analysis of changes in orbital volume, eyelid parameters, and eyeball position. Eye (Lond) 36(3):547–554. https://doi.org/10.1038/s41433-021-01480-7CrossRefPubMed

14.

Seibel I, Hofmann VM, Sönmez H et al (2017) Medial and mediolateral orbital decompression in intractable Graves’ Orbitopathy. Auris Nasus Larynx 44(4):428–434. https://doi.org/10.1016/j.anl.2016.08.007CrossRefPubMed

15.

Sellari-Franceschini S, Rocchi R, Marinò M et al (2018) Rehabilitative orbital decompression for Graves’ orbitopathy: results of a randomized clinical trial. J Endocrinol Invest 41(9):1037–1042. https://doi.org/10.1007/s40618-018-0847-7CrossRefPubMed

16.

Takahashi Y, Nakamura Y, Ichinose A et al (2014) Intraocular pressure change with eye positions before and after orbital decompression for thyroid eye disease. Ophthalmic Plast Reconstr Surg 30(1):47–50. https://doi.org/10.1097/IOP.0000000000000007CrossRefPubMed

17.

Xu H, Wu T, Sun F et al (2020) Comparison of the effects of balanced orbital decompression and endoscopic transnasal inferomedial wall decompression with the high orbital pressure. Chinese J Exp Ophthalmol 38:967–972

18.

Gioacchini FM, Kaleci S, Cassandro E et al (2021) Orbital wall decompression in the management of Graves’ orbitopathy: a systematic review with meta-analysis. Eur Arch Otorhinolaryngol 278(11):4135–4145. https://doi.org/10.1007/s00405-021-06698-5CrossRefPubMed

19.

Willaert R, Maly T, Ninclaus V et al (2020) Efficacy and complications of orbital fat decompression in Graves’ orbitopathy: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 49(4):496–504. https://doi.org/10.1016/j.ijom.2019.08.009CrossRefPubMed

20.

Stranc M, West M (1988) A four-wall orbital decompression for dysthyroid orbitopathy. J Neurosurg 68(5):671–677. https://doi.org/10.3171/jns.1988.68.5.0671CrossRefPubMed

21.

Cheng SN, Yu YQ, You YY et al (2021) Comparison of 2-wall versus 3-wall orbital decompression against dysthyroid optic neuropathy in visual function: a retrospective study in a Chinese population. Medicine (Baltimore) 100(8):e24513. https://doi.org/10.1097/MD.0000000000024513CrossRefPubMed

22.

Finn AP, Bleier B, Cestari DM et al (2017) A retrospective review of orbital decompression for thyroid orbitopathy with endoscopic preservation of the inferomedial orbital bone strut. Ophthalmic Plast Reconstr Surg 33(5):334–339. https://doi.org/10.1097/IOP.0000000000000782CrossRefPubMed

23.

Kuechlin S, Steiert C, Naseri Y et al (2021) Pterional orbit decompression in Grave disease with dysthyroid optic neuropathy. World Neurosurg 149:e1007–e1016. https://doi.org/10.1016/j.wneu.2021.01.040CrossRefPubMed

Title: A meta-analysis of the efficacy of two-wall orbital decompression operations for thyroid-associated ophthalmopathy
Authors: Yu Jinhai
Chen Yunxiu
Xiong Chao
Wang Yaohua
Yuan Kai
Liao Hongfei
Publication date: 01-12-2024
Publisher: Springer Netherlands
Keyword: Diplopia
Published in: International Ophthalmology / Issue 1/2024
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-024-03039-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A meta-analysis of the efficacy of two-wall orbital decompression operations for thyroid-associated ophthalmopathy

Abstract

Background

Aims

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Correction: Assessment of the levels of interleukin-17 and interleukin-38 in thyroid-associated ophthalmopathy patients

Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis

Evaluation of the (Baha) technique of scleral indentation using a self-retained scleral indenter during vitrectomy surgery: a randomized trial

Subthreshold micropulse diode laser treatment in diabetic macular edema: biological impact, therapeutic effects, and safety

Anterior chamber flare and choroidal vascular index as inflammatory markers after uncomplicated phacoemulsification surgery

The practical and educational value of scleral buckling with chandelier illumination