Transnasal endoscopic orbital decompression in the algorithm of surgical treatment of endocrine ophthalmopathy

Kochetkov P.A.; Grusha Y.O.; Svistushkin V.M.; Ismailova D.S.; Sviridenko N.Yu.; Duvanova E.D.

doi:https://doi.org/10.17116/otorino20228703113

Kochetkov P.A.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-5778-629X

Grusha Y.O.

I.M. Sechenov First Moscow State Medical University (Sechenov University);
Krasnov Research Institute of Eye Diseases

ORCID: 0000-0002-6461-8243

Svistushkin V.M.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-1257-9879

Ismailova D.S.

Research Institute of Eye Diseases

Sviridenko N.Yu.

National Medical Research Center for Endocrinology

ORCID: 0000-0002-8538-5354

Duvanova E.D.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-0099-2332

Transnasal endoscopic orbital decompression in the algorithm of surgical treatment of endocrine ophthalmopathy

Authors:

Kochetkov P.A., Grusha Y.O., Svistushkin V.M., Ismailova D.S., Sviridenko N.Yu., Duvanova E.D.

More about the authors

Journal: Russian Bulletin of Otorhinolaryngology. 2022;87(3): 13‑18

DOI: 10.17116/otorino20228703113

Read: 2688 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Kochetkov PA, Grusha YO, Svistushkin VM, Ismailova DS, Sviridenko NYu, Duvanova ED. Transnasal endoscopic orbital decompression in the algorithm of surgical treatment of endocrine ophthalmopathy. Russian Bulletin of Otorhinolaryngology. 2022;87(3):13‑18. (In Russ.)
https://doi.org/10.17116/otorino20228703113

Подписка 2026 Вестник оториноларингологии (Russian Bulletin of Otorhinolaryngology)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To develop an algorithm for the use of transnasal endoscopic orbital decompression (TEOD) in endocrine ophthalmopathy (EOP).

MATERIAL AND METHODS

The results of 225 TEODs are analyzed. 139 patients with EOP were under observation, who were divided into two groups. Group 1 included 64 patients with an inactive form of EOP, group 2 included 75 patients with EOP complicated by optical neuropathy. Group 2 patients are divided into three subgroups. In the first subgroup there were 36 patients who underwent only TEDO, in the second subgroup there were 17 patients who underwent simultaneous TEOD and lateral bone orbital decompression (LBOD), in the third subgroup there were 22 patients who underwent TEOD and with an interval of 7-14 days — LBOD. After surgery, visual acuity, visual fields and color perception, regression of exophthalmos, as well as the presence of strabismus and diplopia were evaluated.

RESULTS

In patients of group 1 (64 patients, 104 TEODs), the average regression rate of exophthalmos was 5.49±1.22. Diplopia was observed in 23 (36%) patients, strabismus — in 18 (28%) patients. The transient nature of diplopia and strabismus was noted in 11% of cases. Patients of the first subgroup showed an increase in visual acuity from 0.4±0.28 to 0.7±0.2 (p<0.05). Strabismus and diplopia were observed in 54% of cases. In the subgroup with step-by-step performed TEOD and LBOD, the increase in visual acuity was more pronounced and amounted to 74% (from 0.78±0.71 to 0.2±0.3 according to LogMAR, p<0.05), postoperative strabismus and diplopia remained at a high level — 40% of the number of surgical operations performed. The best results of improving visual functions were obtained in patients of the second subgroup with simultaneous TEOD and LBOD (balanced orbital decompression): the increase in visual acuity was 79% (from 0.57±0.47 to 0.12±0.2 according to LogMAR, p<0.05). In patients of this subgroup, strabismus develops less frequently (22% of the number of operated orbits).

CONCLUSION

Transnasal endoscopic decompression of the orbit in the inactive form of the disease is indicated for exophthalmos of more than 4-8 mm. In optical neuropathy, transnasal endoscopic orbital decompression is indicated regardless of the initial visual acuity of the patient and should be supplemented with lateral bone orbital decompression with visual acuity below 0.1. The obtained results allowed us to form an algorithm for surgical treatment of patients with endocrine ophthalmopathy and optical neuropathy using transnasal endoscopic orbital decompression as a surgical intervention.

Keywords:

endocrine ophthalmopathy

optical neuropathy

lateral bone orbital decompression

transnasal endoscopic orbital decompression

diplopia

strabismus

Authors:

Kochetkov P.A.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-5778-629X

Grusha Y.O.

I.M. Sechenov First Moscow State Medical University (Sechenov University);
Krasnov Research Institute of Eye Diseases

ORCID: 0000-0002-6461-8243

Svistushkin V.M.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-1257-9879

Ismailova D.S.

Research Institute of Eye Diseases

Sviridenko N.Yu.

National Medical Research Center for Endocrinology

ORCID: 0000-0002-8538-5354

Duvanova E.D.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-0099-2332

Received:

31.12.2021

Accepted:

14.02.2022

Close metadata

References:

Schaefer SD, Soliemanzadeh P, Della Rocca DA, Yoo GP, Maher EA, Milite JP, Della Rocca RC. Endoscopic and transconjunctival orbital decompression for thyroid-related orbital apex compression. Laryngoscope. 2003;113(3):508-513. https://doi.org/10.1097/00005537-200303000-00021
Levy J, Puterman M, Lifshitz T, Marcus M, Segal A, Monos T. Endoscopic orbital decompression for Graves’ ophthalmopathy. The Israel Medical Association Journal: IMAJ. 2004;6(11):673-676.
Cascone P, Rinna C, Reale G, Calvani F, Iannetti G. Compression and stretching in Graves orbitopathy: emergency orbital decompression techniques. Journal Craniofacial Surgery. 2012;23(5):1430-1433. https://doi.org/10.1097/SCS.0b013e31825e3acf
Khong JJ, Finch S, De Silva C, Rylander S, Craig JE, Selva D, Ebeling PR. Risk factors for Graves’ Orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) study. Journal Clinical Endocrinology and Metabolism. 2016;101(7):2711-2720. https://doi.org/10.1210/jc.2015-4294
Marcocci C, Pinchera A, Marinò M. A treatment strategy for Graves’ orbitopathy. Nature Clinical Practice. Endocrinology and Metabolism. 2007;3(5):430-436. https://doi.org/10.1038/ncpendmet0500
Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits MP, Perros P, Boboridis K, Boschi A, Currò N, Daumerie C, Kahaly GJ, Krassas G, Lane CM, Lazarus JH, Marinò M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM. Consensus statement of the European group on Graves’ orbitopathy (EUGOGO) on management of Graves’ orbitopathy. Thyroid. 2008;18(3):333-346. https://doi.org/10.1089/thy.2007.0315
Kochetkov PA, Gtusha YaO, Svistushkin VM, Danilov SS. The complications of transethmoidal decompressive orbitotomy associated with endocrine ophthalmopathy. Vestnik otorinolaringologii. 2017;82(2):33-37. (In Russ.). https://doi.org/10.17116/otorino201782233-37
Choe CH, Cho RI, Elner VM. Comparison of lateral and medial orbital decompression for the treatment of compressive optic neuropathy in thyroid eye disease. Ophthalmic Plastic and Reconstructive Surgery. 2011;27(1):4-11. https://doi.org/10.1097/IOP.0b013e3181df6a87
Kochetkov PA, Savvateeva DM, Lopatin AS. Orbital decompression review of surgical approaches and analyses of effective. Rossijskaya rinologiya. 2013;21(1):28-34. (In Russ.).
Kochetkov PA. Aspects of endocrine ophthalmopathy surgical treatment by ENT specialist. Klinicheskaya i eksperimental’naya tireoidologiya. 2017;13(3):29-35. (In Russ.). https://doi.org/10.14341/ket2017329-35
Kochetkov PA, Sviridenko NYu. Endonasal endoscopic transethmoidal orbital decompression for patients with Graves’ desease and endocrine ophthalmopathy. Klinicheskaya i eksperimental’naya tireoidologiya. 2010;6(1):26-31. (In Russ.). https://doi.org/10.14341/ket20106126-31
Brovkina AF, Yatsenko OYu, Aubakirova AS. KT priznaki izmenenij ekstraokulyarnykh myshts i retrobul’barnoj kletchatki pri otechnom ekzoftal’me. Materialy nauchno-prakticheskoi konferentsii «Sakharnyj diabet i glaz». M. 2006. (In Russ.).
Sellari-Franceschini S, Berrettini S, Santoro A, Nardi M, Mazzeo S, Bartalena L, Mazzi B, Tanda ML, Marcocci C, Pinchera A. Orbital decompression in Graves’ ophthalmopathy by medial and lateral wall removal. Otolaryngology — Head and Neck Surgery. 2005;133(2):185-189. https://doi.org/10.14639/0392-100X-1082
Pletcher SD, Sindwani R, Metson R. Endoscopic orbital and optic nerve decompression. Otolaryngologic Clinics of North America. 2006;39(5):943-vi. https://doi.org/.1016/j.otc.2006.01.004
Bartalena L, Wiersinga WM, Pinchera A. Graves’ ophthalmopathy: state of the art and perspectives. Journal Endocrinological Investigation. 2004;27(3):295-301. https://doi.org/10.1007/BF03345280
Neigel JM, Rootman J, Belkin RI, Nugent RA, Drance SM, Beattie CW, Spinelli JA. Dysthyroid optic neuropathy. The crowded orbital apex syndrome. Ophthalmology. 1988;95(11):1515-1521. https://doi.org/10.1016/s0161-6420(88)32978-7
Avetisov SE, Grusha YaO, Ismailova DS, Kochetkov PA, Danilov SS, Sviridenko NYu. Surgical rehabilitation of patients with thyroid eye disease: systematic approach. Vestnik oftal’mologii. 2017;133(1):4-10. (In Russ.). https://doi.org/10.17116/oftalma201713314-10
Autoimmunnaya patalogiya shchitovidnoj zhelezy. Dedov II, Melnichenko GA, eds. M.: Tipografiya «Pechatnykh del master»; 2020. (In Russ.).
Grusha YaO, Ismailova DS, Kochetkov PA, Danilov SS. Potentials of intraoperative navigation during balanced orbital bony decompression in thyroid eye disease (preliminary results). Vestnik oftal’mologii. 2016;132(4):29-34. (In Russ.). https://doi.org/10.17116/oftalma2016132429-34