phenylephrine-hydrochloride and Graves-Ophthalmopathy

Based on the anatomic relationship between sinonasal complex and orbit, endoscopic transnasal procedures could be a smart solution for approaching the medial orbital region. These techniques should be considered a valid option for optic nerve or orbital wall decompression in cases of Graves ophthalmopathy and post-traumatic optic neuropathy as well as for addressing extraconal or intraconal lesions placed medially to the optic nerve course. This article describes the anatomic principles, indications, technical nuances, and limitations of the endoscopic endonasal approaches for the management of selected orbital pathologic abnormalities.

Topics: Decompression, Surgical; Endoscopy; Graves Ophthalmopathy; Humans; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Nose; Optic Nerve Injuries; Orbital Diseases; Paranasal Sinus Neoplasms

To analyse the efficacy of various surgical methods for the treatment of endocrine ophthalmopathy and to estimate the potential of endonasal endoscopic surgery for the management of this pathology. The available literature publications concerning surgical treatment of endocrine ophthalmopathy were reviewed; their data were compared with the results of endoscopic endonasal surgery performed by the authors. Various surgical techniques including those with the use of external and endonasal transethmoidal approachers are discussed with special emphasis on the resection of the medial and inferior orbital walls. The analysis of surgical techniques, peculiarities of postoperative treatment, and its outcomes is presented. This study has demonstrated the advantages of endonasal endoscopic transethmoidal decompression of the orbit over the external surgical approach used to manage endocrine ophthalmopathy.

Topics: Decompression, Surgical; Endoscopy; Ethmoid Sinus; Graves Ophthalmopathy; Humans; Nasal Surgical Procedures; Nose; Ophthalmologic Surgical Procedures; Orbit

The paper is designed to discuss the possibilities for the extension of indications to endonasal endoscopic surgery. Original experience with the surgical treatment of endocrine ophthalmopathy in patients with pharmacologically compensated thyroid dysfunction and clinical manifestations of exophthalmus is presented. A total of 6 operations were made through the transethmoidal approach with the resection of medial and inferior orbital walls. Regression of exophthalmus from 3.5 to 6 mm was achieved in 5 patients. Postoperative diplopia was documented in two patients within 3 weeks after surgery. Five patients enjoyed improvement of vision and quality of life due to correction of the cosmetic eye defect. None of the patients developed purulent complications affecting orbital tissues and paranasal sinuses. Surgical techniques and peculiarities of postoperative patient care are discussed.

Topics: Decompression, Surgical; Endoscopy; Ethmoid Sinus; Graves Ophthalmopathy; Humans; Nose; Treatment Outcome

To examine the characteristics of excyclotropia correction through surgery on the inferior rectus muscle in patients with thyroid eye disease.. This was a retrospective, observational study at a single institution. We reviewed 36 patients who had undergone unilateral inferior rectus muscle recession, with or without nasal inferior rectus muscle transposition. The following factors were investigated as possibly influencing excyclotropia correction: inferior rectus muscle thickness, degree of adipose change in the inferior rectus muscle, smoking status, history of orbital radiotherapy, and the amount of inferior rectus muscle recession. Using T1-weighted coronal magnetic resonance imaging, we measured the cross-sectional area of the inferior rectus muscle at its largest point, as well as the bright-signal area of the inferior rectus muscle, which reflects intermuscular adipose change. We then calculated the percentage internal bright-signal area at the point of the largest inferior rectus muscle cross-sectional area. The history of orbital radiotherapy was graded using a binary system. We evaluated correlations among excyclotropia correction, the amount of nasal inferior rectus muscle transposition, and the possible influencing factors listed, using stepwise multiple regression analyses.. The multiple regression model demonstrated a significant relationship among excyclotropia correction, amount of nasal inferior rectus muscle transposition, and the amount of inferior rectus muscle recession (YCORRECTION = 8.546XTENDON WIDTH + 0.405XRECESSION- 0.908; r = 0.844; adjusted r2 = 0.695; P < 0.001).. Excyclotropia correction was correlated with the amount of nasal inferior rectus muscle transposition and the amount of inferior rectus muscle recession, but not with the other factors. The regression model presented in this study will enable us to determine more precisely the amount of nasal inferior rectus muscle transposition in patients with excyclotropia of various angles.

Topics: Adipose Tissue; Adult; Aged; Eye; Female; Graves Ophthalmopathy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nose; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Regression Analysis; Retrospective Studies; Strabismus; Thyroid Gland

To present the results and evaluate the efficacy of endoscopic transnasal orbital decompression for dysthyroid orbitopathy.. Retrospective chart review of patients who underwent endoscopic transnasal orbital decompression from 1996 to 2010 in one institution. We included 42 orbits of 25 patients. Preoperative and postoperative examinations included visual acuity, Hertel exophthalmometry, tonometry, exposure keratitis, and diplopia. The measurements of outcome depend on proptosis reduction, intraocular pressure reduction, and visual acuity improvement of 42 orbits of 25 patients.. There were no surgical complications for the 42 orbital decompressions except one patient experienced cerebrospinal fluid leak during the operation. Mean proptosis reduction in all orbits was 1.93 ± 0.25 (mean ± standard deviation, p < 0.01) after 1 month postoperatively and 2.07 ± 0.29 (p < 0.01) after 3 months postoperatively. An average reduction of intraocular pressure was 4.40 ± 0.72 (p < 0.01) and 4.38 ± 0.80 (p < 0.01) respectively after 1 and 3 months postoperatively. Visual acuity increased from a preoperative average of 0.45 ± 0.34 to 0.66 ± 0.36 and 0.70 ± 0.35 after 1 and 3 months postoperatively. In addition, postoperative relief of exposure keratitis is also noted.. The transnasal orbital decompression procedure has statistically significant improvements in proptosis, intraocular pressure, and visual acuity. The procedure has obvious benefit in relieving exposure keratitis. Furthermore, there are favorable cosmetic results and rare complications.

Topics: Adult; Aged; Aged, 80 and over; Decompression, Surgical; Female; Forecasting; Graves Ophthalmopathy; Humans; Incidence; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Retrospective Studies; Taiwan; Visual Acuity

Present our experience with orbital decompression using an endoscopic transnasal approach and test whether preservation of an anteroposterior periorbital strip overlying the medial rectus muscle can reduce the incidence of postoperative diplopia.. Retrospective, descriptive study conducted on 16 patients with Graves ophthalmopathy operated on with orbital decompression between 2004 and 2009.. Twelve women and four men (mean age, 34.6 years), a total of 30 orbits, were operated. A medial periorbital strip along the medial rectus muscle was preserved in 13 patients. A single case (7.7%) presented postoperative diplopia. The mean reduction of proptosis was 4.3mm.. The endoscopic transnasal approach provides comparable results to those obtained with other techniques. The incidence of postoperative diplopia seems to decrease when an anteroposterior periorbital periosteal strip is preserved along the medial rectus muscle.

Topics: Adult; Decompression, Surgical; Diplopia; Endoscopy; Female; Graves Ophthalmopathy; Humans; Male; Middle Aged; Nose; Postoperative Complications; Retrospective Studies; Young Adult