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Balanced medial–lateral wall vs selective 3-wall orbital decompression for sight-threatening Graves’s orbitopathy: a clinical retrospective cohort study from 2016 to 2022

  • Rhinology
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Abstract

Purpose

Although urgent orbital decompression surgery for sight-threatening Graves’ orbitopathy unresponsive to available medical treatments continues to evolve, post-operative new-onset or worsened pre-operative strabismus or diplopia remains a significant complication. At present, the optimal surgical technique remains debatable. Here, we sought to compare long-term outcomes after balanced medial–lateral wall versus selective 3-wall decompression as an urgent treatment for unresponsive sight-threatening GO.

Methods

This retrospective study examined the post-operative outcome of 102 eyes (57 patients) that underwent urgent orbital decompression for sight-threatening GO. Treatment effectiveness was measured by visual acuity, proptosis, perimetry, and strabismus/diplopia, while fundus findings were detected by fundus color photography and optical coherence tomography and followed up for more than 12 months.

Results

Fifty-seven patients (102 orbits) with an average age of 52.7 ± 10.2 years were evaluated. Balanced medial–lateral wall (BMLW-OD) or selective 3-wall decompression(S3W-OD) were performed in 54 and 48 eyes, respectively. Twelve months after orbital decompression, all parameters significantly improved in both groups, including best-corrected visual acuity (BCVA), mean defect of visual field (VF-MD), pattern standard deviation of visual field (VF-PSD), and proptosis (all P < 0.01). However, new-onset esotropia occurred in 25.8% and 3.8% of patients who underwent BMLW-OD surgery or S3W-OD, respectively. Moreover, 6.5% and 38.5% of patients improved after decompression in the medial–lateral wall decompression group and the selective 3-wall decompression group, respectively.

Conclusions

We demonstrated that S3W-OD provides a lower rate of new-onset strabismus/diplopia as compared with BMLW-OD surgery, while still allowing for satisfactory visual outcomes.

Trial registration number : 

NCT05627401. Date of registration: November 25, 2022.

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Funding

This study was supported by research grants from the Science and Technology Bureau of Guangzhou (grant numbers 2021–02–01–04–0203). Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Author notes

  1. Peng Tian and Peng Zeng have contributed equally to this work.

Authors and Affiliations

  1. Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China

    Peng Tian, Haixia Zhang, Yun Ma, Hua Zou & Liu Xiang

  2. Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guang Zhou, 510120, China

    Peng Zeng, Jiaqi Liang, Erxun Li & Mei Wang

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  1. Peng Tian
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Contributions

PT and PZ wrote the first draft of the manuscript. HZ, EL and JL collected and analyzed data. Yun Ma Hua Zou critically revised the manuscript. MW and XL contributed to the conception and design of the study. All authors read and approved the submitted version of the manuscript.

Corresponding author

Correspondence to Liu Xiang.

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Conflict of interest

The authors declare no competing interests regarding the publication of this paper.

Ethical approval

This study was registered on ClinicalTrials.gov (NCT05627401) and conducted in accordance with the Declaration of Helsinki and received ethics committee approval from Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University (SYSKY-2022-349-01). All the data from hospital records remained anonymized.

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Tian, P., Zeng, P., Zhang, H. et al. Balanced medial–lateral wall vs selective 3-wall orbital decompression for sight-threatening Graves’s orbitopathy: a clinical retrospective cohort study from 2016 to 2022. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08589-x

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