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Transcaruncular Orbital Decompression for Management of Compressive Optic Neuropathy in Thyroid-Related Orbitopathy

Chang, Eli L. M.D.; Bernardino, Carlo R. M.D.; Rubin, Peter A. D. M.D.

Plastic and Reconstructive Surgery: September 1st, 2003 - Volume 112 - Issue 3 - p 739-747
doi: 10.1097/01.PRS.0000069708.70121.67

This study was conducted to assess the outcome of transcaruncular orbital decompression to treat compressive optic neuropathy in thyroid-related orbitopathy. It involved a retrospective, noncomparative case series of 18 eyes of 10 consecutive patients with documented vision loss secondary to thyroid-related orbitopathy. Bony decompression of the orbital apex was performed via a transcaruncular approach. Main outcome measures were visual acuity, color vision, presence of diplopia, and reduction of exophthalmos. Of 18 eyes, 16 (89 percent) had improved visual acuity after the operation. One eye had no improvement and one had worsening of vision in the setting of diabetic retinopathy. Color vision was improved in 12 eyes (67 percent). Five of the patients did not have diplopia before the operation; none of these patients developed double vision after intervention. Exophthalmos was decreased by an average of 2.6 mm. The authors conclude that transcaruncular orbital decompression for compressive optic neuropathy in thyroid-related orbitopathy is successful in restoring visual function. Compared with other approaches used for decompression surgery, the transcaruncular approach offers direct access to the medial wall and orbital apex without a cutaneous incision or disruption of the medial canthus. In addition, this approach allows a controlled, graded removal of the ethmoidal air cells and reduced recovery time.

Boston, Mass.

From the Department of Ophthalmic Plastic, Orbital and Cosmetic Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School.

Received for publication May 31, 2002;

revised November 13, 2002.

Peter A. D. Rubin, M.D.

Massachusetts Eye and Ear Infirmary

Harvard Medical School

Ophthalmic Plastic, Orbital & Cosmetic Surgery

243 Charles Street

Boston, Mass. 02114

©2003American Society of Plastic Surgeons