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Authors Gong Y, Yin J, Tong B, Li JK, Zeng J, Zuo Z, Ye F, Luo YH, Xiao J, Xiong W
Received 10 October 2017
Accepted for publication 22 January 2018
Published 26 March 2018 Volume 2018:14 Pages 607—616
DOI https://doi.org/10.2147/TCRM.S153733
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Hoa Le
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Background: Orbital decompression is an important surgical procedure for
treatment of Graves’ ophthalmopathy (GO), especially in women. It is reasonable
for balanced orbital decompression of the lateral and medial wall. Various
surgical approaches, including endoscopic transnasal surgery for medial wall
and eye-side skin incision surgery for lateral wall, are being used nowadays,
but many of them lack the validity, safety, or cosmetic effect.
Patients and
methods: Endoscopic orbital decompression of
lateral wall through hairline approach and decompression of medial wall via
endoscopic transnasal surgery was done to achieve a balanced orbital
decompression, aiming to improve the appearance of proptosis and create
conditions for possible strabismus and eyelid surgery afterward. From January
29, 2016 to February 14, 2017, this surgery was performed on 41 orbits in 38
patients with GO, all of which were at inactive stage of disease. Just before
surgery and at least 3 months after surgery, Hertel’s ophthalmostatometer and
computed tomography (CT) were used to check proptosis and questionnaires of GO
quality of life (QOL) were completed.
Findings: The postoperative retroversion of eyeball was 4.18±1.11 mm (Hertel’s
ophthalmostatometer) and 4.17±1.14 mm (CT method). The patients’ QOL was
significantly improved, especially the change in appearance without facial
scar. The only postoperative complication was local soft tissue depression at
temporal region. Obvious depression occurred in four cases (9.76%), which can
be repaired by autologous fat filling.
Interpretation: This surgery is effective, safe, and cosmetic. Effective balanced
orbital decompression can be achieved by using this original and innovative
surgery method. The whole manipulation is safe and controllable under
endoscope. The postoperative scar of endoscopic surgery through hairline
approach is covered by hair and the anatomic structure of anterior orbit is not
impacted.
Keywords: orbital decompression, Graves’ ophthalmopathy, hairline approach,
endoscopic surgery, lateral wall