Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors
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OCULOPLASTICS AND ORBIT
Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors Aric Vaidya 1 & Patricia Ann L. Lee 1 & Yoshiyuki Kitaguchi 2 & Hirohiko Kakizaki 1 & Yasuhiro Takahashi 1 Received: 12 March 2020 / Revised: 12 May 2020 / Accepted: 19 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate spontaneous decompression of the medial orbital wall and orbital floor in thyroid eye disease using new measurement methods and to analyze the influential factors. Methods This retrospective study included 86 patients (172 sides). Regarding evaluation of spontaneous medial orbital decompression, an anteroposterior line was drawn between the posterior lacrimal crest and the junction between the ethmoid bone and corpus ossis sphenoidalis. The bulged and/or dented areas from that line were measured. Regarding evaluation of spontaneous orbital floor decompression, the length of the perpendicular distance from a line that was drawn between the inferior orbital rim and the orbital process of palatal bone to the tip of the superior bulge of the orbital floor was measured. Results Multivariate linear regression analysis revealed that the maximum cross-sectional areas of the superior rectus/levator palpebrae superioris complex (P = 0.020) and medial rectus muscle (P = 0.028) were influential factors for spontaneous decompression of medial orbital wall (adjusted r2 = 0.090; P < 0.001), whereas the number of cycles of steroid pulse therapy (P = 0.002) and the maximum cross-sectional area of the inferior rectus muscle (P = 0.007) were the ones for that of the orbital floor (adjusted r2 = 0.096; P < 0.001). Conclusion We believe that the identification of multiple influential factors of spontaneous decompression of the medial orbital wall and orbital floor will be helpful for better understanding and planned management of thyroid eye disease patients undergoing orbital decompression surgery. Keywords Spontaneous decompression . Medial wall . Orbital floor . Thyroid eye disease . Compressive optic neuropathy
Introduction Spontaneous orbital decompression is expressed as a flattening (Fig. 1a) and further bowing/fracture (Fig. 1b and c) of a naturally convex-shaped medial orbital wall and orbital floor (Fig. 1d and e) [1, 2]. This is caused by any pathologically elevated intraorbital pressure without any known etiology, such as trauma, orbital surgical history, or orbital bony pathology [1, 2]. As these orbital walls are thin and vulnerable to high intraorbital pressure, expansion of the intraorbital soft tissue in patients with thyroid eye disease (TED) promotes such orbital bone remodeling [1, 3]. Spontaneous orbital * Yasuhiro Takahashi [email protected] 1
Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan
2
Department of Ophthalmology, Osaka University, Suita, Osaka, Japan
decompression reduces the intraorbital pressure at the
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