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Published in: Ophthalmology and Therapy 4/2019

Open Access 01-12-2019 | Original Research

Practice Patterns in Orbital Decompression Surgery Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members

Authors: Sarah W. DeParis, Jing Tian, Fatemeh Rajaii

Published in: Ophthalmology and Therapy | Issue 4/2019

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Abstract

Introduction

Orbital decompression surgery for thyroid-associated orbitopathy (TAO) has evolved greatly over the past decades with the development of new surgical techniques and strategies for patient management. However, randomized controlled trials comparing surgical approaches are lacking. The goal of this study was to report the current preferred practices among American Society of Ophthalmic Plastic Surgeons (ASOPRS) members for orbital decompression surgery for TAO, including surgical techniques and perioperative patient management.

Methods

An anonymous electronic survey consisting of 21 questions was sent to the current membership of the ASOPRS, leading to 170 responses in total (response rate: 23.7%). Questions regarding preoperative and postoperative care as well as surgical technique were included.

Results

54.2% of the respondents prefer two-wall surgery as their initial procedure of choice. Of these, 53.8% prefer balanced lateral and medial decompression as the two-walled procedure of choice, and 44.0% prefer the orbital floor and medial wall. Steroids are routinely used preoperatively by 35.9% and postoperatively by 69.2%. Antibiotics are used preoperatively by 32.9% and postoperatively by 56.4% of respondents.

Conclusion

Practice patterns for orbital decompression surgery continue to vary widely among ASOPRS members, but balanced medial and lateral wall decompression has gained in popularity as compared to prior studies. Postoperative steroids are preferred by a majority of members.
Literature
1.
go back to reference Dollinger J. Die Druckentlastung der Augenhöhle durch Entfernung der äuβeren Orbitalwand bei hochgradigem Exophtalmus (Morbus Basedowii) und konsekutiver Hornhauterkrankung. Dtsch Med Wochenschr. 1911;37:1888.CrossRef Dollinger J. Die Druckentlastung der Augenhöhle durch Entfernung der äuβeren Orbitalwand bei hochgradigem Exophtalmus (Morbus Basedowii) und konsekutiver Hornhauterkrankung. Dtsch Med Wochenschr. 1911;37:1888.CrossRef
2.
go back to reference Walsh TE, Ogura JH. Transantral orbital decompression for malignant exophthalmos. Laryngoscope. 1957;67:544–68.CrossRefPubMed Walsh TE, Ogura JH. Transantral orbital decompression for malignant exophthalmos. Laryngoscope. 1957;67:544–68.CrossRefPubMed
3.
go back to reference Tessier P. Surgical widening of the orbit. Orbits too small. Basedow exophtalmos. Exorbitisms of cranio-facial dysostosis. Congenital anophthalmia, mivrophalmia. Orbital atresia of young enucleasted eyes. Orbital tumors (angioma, meningioma, Recklinghausen). Ann Chir Plast. 1969;14:207–14.PubMed Tessier P. Surgical widening of the orbit. Orbits too small. Basedow exophtalmos. Exorbitisms of cranio-facial dysostosis. Congenital anophthalmia, mivrophalmia. Orbital atresia of young enucleasted eyes. Orbital tumors (angioma, meningioma, Recklinghausen). Ann Chir Plast. 1969;14:207–14.PubMed
5.
go back to reference Leone CR Jr, Piest KL, Newman RJ. Medial and lateral wall decompression for thyroid ophthalmopathy. Am J Ophthalmol. 1989;108:160–6.CrossRefPubMed Leone CR Jr, Piest KL, Newman RJ. Medial and lateral wall decompression for thyroid ophthalmopathy. Am J Ophthalmol. 1989;108:160–6.CrossRefPubMed
6.
go back to reference Kennedy DW, Goodstein ML, Miller NR, Zinreich SJ. Endoscopic transnasal orbital decompression. Arch Otolaryngol Head Neck Surg. 1990;116:275–82.CrossRefPubMed Kennedy DW, Goodstein ML, Miller NR, Zinreich SJ. Endoscopic transnasal orbital decompression. Arch Otolaryngol Head Neck Surg. 1990;116:275–82.CrossRefPubMed
7.
go back to reference Kacker A, Kazim M, Murphy M, Trokel S, Close LG. “Balanced” orbital decompression for severe Graves’ orbitopathy: technique with treatment algorithm. Otolaryngol Head Neck Surg. 2003;128:228–35.CrossRefPubMed Kacker A, Kazim M, Murphy M, Trokel S, Close LG. “Balanced” orbital decompression for severe Graves’ orbitopathy: technique with treatment algorithm. Otolaryngol Head Neck Surg. 2003;128:228–35.CrossRefPubMed
8.
go back to reference Goldberg RA, Perry JD, Hortaleza V, Tong JT. Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy. Ophthalmic Plast Reconstr Surg. 2000;16:271–7.CrossRefPubMed Goldberg RA, Perry JD, Hortaleza V, Tong JT. Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy. Ophthalmic Plast Reconstr Surg. 2000;16:271–7.CrossRefPubMed
9.
go back to reference McCann JD, Goldberg RA, Anderson RL, Burroughs JR, Ben Simon GJ. Medial wall decompression for optic neuropathy but lateral wall decompression with fat removal for non vision-threatening indications. Am J Ophthalmol. 2006;141:916–7.CrossRefPubMed McCann JD, Goldberg RA, Anderson RL, Burroughs JR, Ben Simon GJ. Medial wall decompression for optic neuropathy but lateral wall decompression with fat removal for non vision-threatening indications. Am J Ophthalmol. 2006;141:916–7.CrossRefPubMed
10.
go back to reference Sundar G, Chiam N, Lun K, Koh V. Survey of common practices among oculofacial surgeons in the Asia-Pacific region: Graves’ orbitopathy. Orbit. 2014;33:319–25. Sundar G, Chiam N, Lun K, Koh V. Survey of common practices among oculofacial surgeons in the Asia-Pacific region: Graves’ orbitopathy. Orbit. 2014;33:319–25.
11.
go back to reference Perumal B, Meyer DR. Treatment of severe thyroid eye disease: a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Ophthalmic Plast Reconstr Surg. 2015;31:127–31.CrossRefPubMed Perumal B, Meyer DR. Treatment of severe thyroid eye disease: a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Ophthalmic Plast Reconstr Surg. 2015;31:127–31.CrossRefPubMed
12.
go back to reference Reich SS, Null RC, Timoney PJ, Sokol JA. Trends in orbital decompression techniques of surveyed American Society of Ophthalmic Plastic and Reconstructive Surgery members. Ophthalmic Plast Reconstr Surg. 2016;32:434–7.CrossRefPubMed Reich SS, Null RC, Timoney PJ, Sokol JA. Trends in orbital decompression techniques of surveyed American Society of Ophthalmic Plastic and Reconstructive Surgery members. Ophthalmic Plast Reconstr Surg. 2016;32:434–7.CrossRefPubMed
13.
go back to reference Leong SC, Karkos PD, Macewen CJ, White PS. A systematic review of outcomes following surgical decompression for dysthyroid orbitopathy. Laryngoscope. 2009;119:1106–15.CrossRefPubMed Leong SC, Karkos PD, Macewen CJ, White PS. A systematic review of outcomes following surgical decompression for dysthyroid orbitopathy. Laryngoscope. 2009;119:1106–15.CrossRefPubMed
14.
go back to reference Sellari-Franceschini S, Dallan I, Bajraktari A, et al. Surgical complications in orbital decompression for Graves’ orbitopathy. Acta Otorhinolaryngol Ital. 2016;36:265–74.CrossRefPubMedPubMedCentral Sellari-Franceschini S, Dallan I, Bajraktari A, et al. Surgical complications in orbital decompression for Graves’ orbitopathy. Acta Otorhinolaryngol Ital. 2016;36:265–74.CrossRefPubMedPubMedCentral
15.
go back to reference Mourits MP, Bijl H, European Group on Graves’ Orbitopathy, et al. Outcome of orbital decompression for disfiguring proptosis in patients with Graves’ orbitopathy using various surgical procedures. Br J Ophthalmol. 2009;93:1518–23. Mourits MP, Bijl H, European Group on Graves’ Orbitopathy, et al. Outcome of orbital decompression for disfiguring proptosis in patients with Graves’ orbitopathy using various surgical procedures. Br J Ophthalmol. 2009;93:1518–23.
16.
go back to reference Boboridis KG, Bunce C. Surgical orbital decompression for thyroid eye disease. Cochrane Database Syst Rev. 2011;CD007630. Boboridis KG, Bunce C. Surgical orbital decompression for thyroid eye disease. Cochrane Database Syst Rev. 2011;CD007630.
17.
go back to reference Pliego-Maldonado A, Miranda-Ruiz R, Vargas-Aguayo A, Marin-Mendez JA, Pena-Garcia JF, Guerra-Lopez J. Orbit decompression surgery in patients with exophthalmos caused by Graves-Basedow disease. Gac Med Mex. 2000;136:11–5. Pliego-Maldonado A, Miranda-Ruiz R, Vargas-Aguayo A, Marin-Mendez JA, Pena-Garcia JF, Guerra-Lopez J. Orbit decompression surgery in patients with exophthalmos caused by Graves-Basedow disease. Gac Med Mex. 2000;136:11–5.
18.
go back to reference Wakelkamp IM, Baldeschi L, Saeed P, Mourits MP, Prummel MF, Wiersinga WM. Surgical or medical decompression as a first-line treatment of optic neuropathy in Graves’ ophthalmopathy? A randomized controlled trial. Clin Endocrinol (Oxf). 2005;63:323–8.CrossRefPubMed Wakelkamp IM, Baldeschi L, Saeed P, Mourits MP, Prummel MF, Wiersinga WM. Surgical or medical decompression as a first-line treatment of optic neuropathy in Graves’ ophthalmopathy? A randomized controlled trial. Clin Endocrinol (Oxf). 2005;63:323–8.CrossRefPubMed
19.
go back to reference Wu CY, Stacey AW, Kahana A. Simultaneous versus staged balanced decompression for thyroid-related compressive optic neuropathy. Ophthalmic Plast Reconstr Surg. 2016;32:462–7.CrossRefPubMed Wu CY, Stacey AW, Kahana A. Simultaneous versus staged balanced decompression for thyroid-related compressive optic neuropathy. Ophthalmic Plast Reconstr Surg. 2016;32:462–7.CrossRefPubMed
20.
go back to reference Millar MJ, Maloof AJ. The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy. Eye (Lond). 2009;23:1565–71.CrossRefPubMed Millar MJ, Maloof AJ. The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy. Eye (Lond). 2009;23:1565–71.CrossRefPubMed
21.
go back to reference Mahoney N, Grant MP, Susarla SM, Merbs S. Computer-assisted three-dimensional planning for orbital decompression. Craniomaxillofac Trauma Reconstr. 2015;8:211–7.CrossRefPubMed Mahoney N, Grant MP, Susarla SM, Merbs S. Computer-assisted three-dimensional planning for orbital decompression. Craniomaxillofac Trauma Reconstr. 2015;8:211–7.CrossRefPubMed
22.
go back to reference Fichter N, Krentz H, Guthoff RF. Functional and esthetic outcome after bony lateral wall decompression with orbital rim removal and additional fat resection in Graves’ orbitopathy with regard to the configuration of the lateral canthal region. Orbit. 2013;32:239–46. Fichter N, Krentz H, Guthoff RF. Functional and esthetic outcome after bony lateral wall decompression with orbital rim removal and additional fat resection in Graves’ orbitopathy with regard to the configuration of the lateral canthal region. Orbit. 2013;32:239–46.
23.
go back to reference Ueland HO, Haugen OH, Rodahl E. Temporal hollowing and other adverse effects after lateral orbital wall decompression. Acta Ophthalmol. 2016;94:793–7.CrossRefPubMed Ueland HO, Haugen OH, Rodahl E. Temporal hollowing and other adverse effects after lateral orbital wall decompression. Acta Ophthalmol. 2016;94:793–7.CrossRefPubMed
24.
go back to reference Siah WF, Patel BC, Malhotra R. Surgical management of temple-related problems following lateral wall rim-sparing orbital decompression for thyroid-related orbitopathy. Br J Ophthalmol. 2016;100:1144–50.CrossRefPubMed Siah WF, Patel BC, Malhotra R. Surgical management of temple-related problems following lateral wall rim-sparing orbital decompression for thyroid-related orbitopathy. Br J Ophthalmol. 2016;100:1144–50.CrossRefPubMed
25.
go back to reference Goldberg RA, Kim AJ, Kerivan KM. The lacrimal keyhole, orbital door jamb, and basin of the inferior orbital fissure. Three areas of deep bone in the lateral orbit. Arch Ophthalmol. 1998;116(12):1618–24.CrossRefPubMed Goldberg RA, Kim AJ, Kerivan KM. The lacrimal keyhole, orbital door jamb, and basin of the inferior orbital fissure. Three areas of deep bone in the lateral orbit. Arch Ophthalmol. 1998;116(12):1618–24.CrossRefPubMed
26.
go back to reference Goldberg RA, Hwang MM, Garbutt MV, Shorr N. Orbital decompression for non-Graves’ orbitopathy: a consideration of extended indications for decompression. Ophthalmic Plast Reconstr Surg. 1995;11:245–52.CrossRefPubMed Goldberg RA, Hwang MM, Garbutt MV, Shorr N. Orbital decompression for non-Graves’ orbitopathy: a consideration of extended indications for decompression. Ophthalmic Plast Reconstr Surg. 1995;11:245–52.CrossRefPubMed
27.
go back to reference Bailey KL, Tower RN, Dailey RA. Customized, single-incision, three-wall orbital decompression. Ophthalmic Plast Reconstr Surg. 2005;21:1–9.CrossRefPubMed Bailey KL, Tower RN, Dailey RA. Customized, single-incision, three-wall orbital decompression. Ophthalmic Plast Reconstr Surg. 2005;21:1–9.CrossRefPubMed
28.
go back to reference Paridaens DA, Verhoeff K, Bouwens D, van Den Bosch WA. Transconjunctival orbital decompression in Graves’ ophthalmopathy: lateral wall approach ab interno. Br J Ophthalmol. 2000;84:775–81.CrossRefPubMedPubMedCentral Paridaens DA, Verhoeff K, Bouwens D, van Den Bosch WA. Transconjunctival orbital decompression in Graves’ ophthalmopathy: lateral wall approach ab interno. Br J Ophthalmol. 2000;84:775–81.CrossRefPubMedPubMedCentral
29.
go back to reference Kakizaki H, Takahashi Y, Ichinose A, Iwaki M, Selva D, Leibovitch I. The importance of rim removal in deep lateral orbital wall decompression. Clin Ophthalmol. 2011;5:865–9.CrossRefPubMedPubMedCentral Kakizaki H, Takahashi Y, Ichinose A, Iwaki M, Selva D, Leibovitch I. The importance of rim removal in deep lateral orbital wall decompression. Clin Ophthalmol. 2011;5:865–9.CrossRefPubMedPubMedCentral
30.
go back to reference Lane KA, Bilyk JR, Taub D, Pribitkin EA. “Sutureless” repair of orbital floor and rim fractures. Ophthalmology. 2009;116:135–8.CrossRefPubMed Lane KA, Bilyk JR, Taub D, Pribitkin EA. “Sutureless” repair of orbital floor and rim fractures. Ophthalmology. 2009;116:135–8.CrossRefPubMed
31.
go back to reference Bartalena L, Baldeschi L, Boboridis K, et al. The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy guidelines for the management of Graves’ orbitopathy. Eur Thyroid J. 2016;5:9–26.CrossRefPubMedPubMedCentral Bartalena L, Baldeschi L, Boboridis K, et al. The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy guidelines for the management of Graves’ orbitopathy. Eur Thyroid J. 2016;5:9–26.CrossRefPubMedPubMedCentral
Metadata
Title
Practice Patterns in Orbital Decompression Surgery Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members
Authors
Sarah W. DeParis
Jing Tian
Fatemeh Rajaii
Publication date
01-12-2019
Publisher
Springer Healthcare
Published in
Ophthalmology and Therapy / Issue 4/2019
Print ISSN: 2193-8245
Electronic ISSN: 2193-6528
DOI
https://doi.org/10.1007/s40123-019-00206-z

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