Ocular motility changes after inferomedial wall and balanced medial plus lateral wall orbital decompression in Graves’ orbitopathy: a randomized prospective comparative study

Authors

  • Cristiane de Almeida Leite Universidade de São Paulo. Faculdade de Medicina. Divisão de Oftalmologia. Laboratório de Investigação em Oftalmologia (LIM 33)
  • Thaís de Sousa Pereira Universidade de São Paulo. Faculdade de Medicina. Divisão de Oftalmologia. Laboratório de Investigação em Oftalmologia (LIM 33)
  • Jeane Chiang Universidade de São Paulo. Faculdade de Medicina. Divisão de Oftalmologia. Laboratório de Investigação em Oftalmologia (LIM 33)
  • Rodrigo Bernal Moritz Universidade de São Paulo. Faculdade de Medicina. Divisão de Oftalmologia. Laboratório de Investigação em Oftalmologia (LIM 33)
  • Allan Christian Pieroni Gonçalves Universidade de São Paulo. Faculdade de Medicina. Divisão de Oftalmologia. Laboratório de Investigação em Oftalmologia (LIM 33)
  • Mário Luiz Ribeiro Monteiro Universidade de São Paulo. Faculdade de Medicina. Divisão de Oftalmologia. Laboratório de Investigação em Oftalmologia (LIM 33)

DOI:

https://doi.org/10.6061/clinics/2021/e2592

Keywords:

Graves Ophthalmopathy, Exophthalmos, Decompression Surgical, Strabismus, Diplopia

Abstract

OBJECTIVES: To compare the surgical outcomes of inferomedial wall orbital decompression (IM-OD) and balanced medial plus lateral wall orbital decompression (ML-OD) in patients with inactive Graves’ orbitopathy (GO) with regard to exophthalmos reduction and ocular motility abnormalities. METHODS: Forty-two patients with inactive GO eligible for OD were randomly assigned to either the IM-OD or ML-OD groups. Pre and postoperative evaluations included Hertel exophthalmometry, sensory, and motor extraocular motility assessment, standardized photographs in the nine gaze positions, and computed tomography (CT) of the orbits. ClinicalTrials.gov: NCT03278964. RESULTS: Exophthalmometry reduction was statistically significant in both groups (po0.001), but was greater in the ML-OD group (p=0.010). New-onset esotropia occurred in 11.1% and 23.5% of patients who underwent IM-OD and ML-OD, respectively, with no statistically significant difference in the frequency of pre and postoperative strabismus in either group. The mean increase in preoperative esotropia was 24±6.9 and 12±8.8 prism diopters in patients who underwent IM-OD and ML-OD, respectively. In the IM-OD group, abduction and elevation worsened at the first (po0.05) and third (po0.05) postoperative visits but were restored at 6 months. The versions did not change postoperatively with ML-OD. The preoperative CT-measured medial rectus muscle area predicted new-onset strabismus (p=0.023). Significant postoperative medial rectus muscle enlargement occurred in both groups (po0.001). Restriction in elevation and abduction was significantly associated with enlarged inferior (p=0.007) and medial rectus muscle areas (p=0.002). CONCLUSIONS: IM-OD is as safe as ML-OD with regard to new-onset strabismus, and represents a good alternative for patients who do not require significant exophthalmos reduction. ML-OD offers greater exophthalmos reduction and smoother postoperative recovery. Patients with preoperative enlarged medial rectus muscle on CT are at risk for new-onset esotropia, and preoperative esotropia is likely to increase after OD.

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Published

2021-11-09

Issue

Section

Original Articles

How to Cite

Leite, C. de A. ., Pereira, T. de S. ., Chiang, J. ., Moritz, R. B. ., Gonçalves, A. C. P. ., & Monteiro, M. L. R. . (2021). Ocular motility changes after inferomedial wall and balanced medial plus lateral wall orbital decompression in Graves’ orbitopathy: a randomized prospective comparative study. Clinics, 76, e2592. https://doi.org/10.6061/clinics/2021/e2592