Division of Ophthalmology and Laboratory for Investigation in Ophthalmology (LIM-33), University of São Paulo Medical School, São Paulo, Brazil.
Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil.
Eye (Lond). 2022 Mar;36(3):547-554. doi: 10.1038/s41433-021-01480-7. Epub 2021 Mar 17.
BACKGROUND/OBJECTIVES: The objective of this study is to investigate and compare changes in orbital volume, eyelid parameters, and eyeball position after inferomedial and balanced (medial + deep lateral walls) orbital decompression (OD) in patients with Graves' orbitopathy (GO).
SUBJECTS/METHODS: Prospective interventional trial. Forty-two patients with inactive GO and clinical indication for OD were randomly assigned to inferomedial or balanced OD. Preoperative and postoperative Hertel exophthalmometry, standardized photography, and computed tomography were used to evaluate upper and lower eyelid margin reflex distances (MRD and MRD), orbital expansion, and changes in eyeball position.
Clinical and radiological exophthalmometry improved significantly after OD with both surgical techniques (p < 0.001), but more so with balanced OD (p = 0.02). Concurrent eyeball descent (p = 0.01) and orbital volume expansion (p < 0.001) were observed with both techniques. The mean decompression volume was similar for the medial wall and the lateral wall but significantly smaller for the inferior wall (p < 0.05). Significant correlation coefficients were found for Hertel reduction vs. total decompression volume (p < 0.05). In the multivariate linear analysis, lateral wall decompression volume (LWDV) was predictive of exophthalmos reduction (p < 0.05). The two techniques produced a similar reduction in MRD and MRD. A significant correlation was also found between Hertel reduction and lower lid elevation (p < 0.05).
Both inferomedial and balanced OD successfully expanded orbit capacity, but the latter was more efficient at reducing exophthalmos probably due to the inclusion of the lateral wall. Upper and lower eyelid retraction improved after OD, but only lower eyelid elevation was correlated with exophthalmos reduction.
背景/目的：本研究旨在探讨和比较在格雷夫斯眼病（GO）患者中进行内侧眶壁切开术和平衡（内侧+深外侧壁）眶减压术（OD）后眶容积、眼睑参数和眼球位置的变化。
受试者/方法：前瞻性干预性试验。42 例静止期 GO 患者，临床指征为 OD，随机分为内侧眶壁切开术或平衡 OD 组。术前和术后采用 Hertel 突眼计、标准化摄影和计算机断层扫描评估上睑和下睑缘退缩距离（MRD 和 MRD）、眶扩张和眼球位置变化。
两种手术技术均可显著改善临床和影像学突眼（p<0.001），但平衡 OD 组改善更明显（p=0.02）。两种技术均观察到眼球下降（p=0.01）和眶容积扩张（p<0.001）。内侧壁和外侧壁的平均减压体积相似，但下壁明显较小（p<0.05）。Hertel 减少与总减压体积之间存在显著的相关系数（p<0.05）。多元线性分析中，外侧壁减压体积（LWDV）是预测突眼减少的因素（p<0.05）。两种技术均可使 MRD 和 MRD 相似地减少。Hertel 减少与下睑抬高之间也存在显著相关性（p<0.05）。
内侧眶壁切开术和平衡 OD 均可成功扩大眶容量，但后者通过包含外侧壁，在减少突眼方面更有效。OD 后上睑和下睑退缩得到改善，但只有下睑抬高与突眼减少相关。
