A randomized comparative study of inferomedial vs. balanced orbital decompression. Analysis of changes in orbital volume, eyelid parameters, and eyeball position

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art_PEREIRA_A_randomized_comparative_study_of_inferomedial_vs_balanced_2022.PDF (1.35 MB)
Citações na Scopus
4
Tipo de produção
article
Data de publicação
2022
DOI
Scopus
Web of Science
PubMed
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Título do Volume
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SPRINGERNATURE
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Citação
EYE, v.36, n.3, p.547-554, 2022
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Unidades Organizacionais
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Resumo
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 (MRD1 and MRD2), orbital expansion, and changes in eyeball position. Results 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 MRD1 and MRD2. A significant correlation was also found between Hertel reduction and lower lid elevation (p < 0.05). Conclusions 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.
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https://observatorio.fm.usp.br/handle/OPI/45996
Referências
  1. Alsuhaibani AH, 2011, OPHTHAL PLAST RECONS, V27, P158, DOI 10.1097/IOP.0b013e3181ef72b3
  2. Chang EL, 2004, ARCH OPHTHALMOL-CHIC, V122, P1882, DOI 10.1001/archopht.122.12.1882
  3. Cho RI, 2011, OPHTHAL PLAST RECONS, V27, P436, DOI 10.1097/IOP.0b013e3182232465
  4. Choi Sang Uk, 2016, Korean J Ophthalmol, V30, P85, DOI 10.3341/kjo.2016.30.2.85
  5. Fichter N, 2013, ORBIT, V32, P239, DOI 10.3109/01676830.2013.788662
  6. GARRITY JA, 1993, AM J OPHTHALMOL, V116, P533, DOI 10.1016/S0002-9394(14)73194-0
  7. Goldberg RA, 1998, ARCH OPHTHALMOL-CHIC, V116, P1618, DOI 10.1001/archopht.116.12.1618
  8. Goldberg RA, 2000, OPHTHALMIC PLAST REC, V16, P271, DOI 10.1097/00002341-200007000-00004
  9. Gonçalves Allan Christian Pieroni, 2005, Arq. Bras. Oftalmol., V68, P445, DOI 10.1590/S0004-27492005000400006
  10. Gupta S, 2013, EXPERT REV OPHTHALMO, V8, P255, DOI 10.1586/EOP.13.10
  11. Kim JW, 2002, OPHTHAL PLAST RECONS, V18, P355, DOI 10.1097/00002341-200209000-00007
  12. Kim KW, 2014, J CRANIO MAXILL SURG, V42, P1286, DOI 10.1016/j.jcms.2014.03.011
  13. Kitaguchi Y, 2019, GRAEF ARCH CLIN EXP, V257, P2759, DOI 10.1007/s00417-019-04500-1
  14. MCCORD CD, 1981, OPHTHALMOLOGY, V88, P533
  15. Milbratz GH, 2012, OPHTHALMOLOGY, V119, P625, DOI 10.1016/j.ophtha.2011.08.039
  16. Mimura LY, 2003, THYROID, V13, P845, DOI 10.1089/105072503322401032
  17. Miot HA, 2009, CLINICS, V64, P885, DOI 10.1590/S1807-59322009000900009
  18. Mourits MP, 2009, BRIT J OPHTHALMOL, V93, P1518, DOI 10.1136/bjo.2008.149302
  19. Mourits MP, 1997, CLIN ENDOCRINOL, V47, P9, DOI 10.1046/j.1365-2265.1997.2331047.x
  20. Park HH, 2018, EYE, V32, P1036, DOI 10.1038/s41433-018-0022-6
  21. Goncalves ACP, 2017, OPHTHAL PLAST RECONS, V33, P446, DOI 10.1097/IOP.0000000000000825
  22. Rha EY, 2015, J CRANIOFAC SURG, V26, pE505, DOI 10.1097/SCS.0000000000002022
  23. Sellari-Franceschini S, 2010, INT J ORAL MAX SURG, V39, P16, DOI 10.1016/j.ijom.2009.10.011
  24. Smith TJ, 2010, J ENDOCRINOL INVEST, V33, P414, DOI 10.1007/BF03346614

Coleções
Artigos e Materiais de Revistas Científicas - FM/MOF
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InRad
Artigos e Materiais de Revistas Científicas - HU
Artigos e Materiais de Revistas Científicas - LIM/33