Orbital decompression for the management of thyroid eye disease: An analysis of outcomes and complications.

OBJECTIVES/HYPOTHESIS: To analyze the clinical outcomes for a large cohort of patients who underwent orbital decompression for thyroid eye disease (TED) utilizing a consistent surgical approach performed by a single surgical team.

STUDY DESIGN: Retrospective case series.

METHODS: Clinical data were gathered for patients who had undergone surgical decompression for TED. Outcomes analysis included reduction in proptosis (millimeters, Hertel measurements), visual acuity change (Snellen chart), diplopia (new or worsening), and complications.

RESULTS: All patients underwent a combined endoscopic transnasal (medial) and transconjunctival (inferior/lateral) approach. A total of 114 surgeries (orbits) were performed on 77 patients during the period 2002 to 2013. Average follow-up was 31.3 months (range, 1-126 months). At last follow up, mean reduction in proptosis across all patients was 3.2 mm (range, 0-9 mm). Postoperatively, no patients reported new diplopia, whereas two patients reported worsening of their existing diplopia (3.8%). Decompression was performed for proptosis in 62 patients (91 orbits), and for compressive optic neuropathy (CON) in 15 patients (23 orbits). When performed for proptosis, mean reduction in proptosis was 3.4 mm. Vision was maintained or improved in all patients, including those presenting with CON.

CONCLUSIONS: Analysis of outcomes in this large cohort showed no new cases of diplopia and only two cases of worsening diplopia balanced with a mean reduction in proptosis consistent with previously reported series. In addition, we demonstrate excellent results stratified by clinical indication (proptosis vs. CON). These results validate the combined endoscopic-transconjunctival approach to orbital decompression for patients with symptomatic TED.

LEVEL OF EVIDENCE: 4.