What are the psychosocial outcomes of treatment for thyroid eye disease? A systematic review

Background: Thyroid eye disease (TED) causes a number of esthetic and visual problems and its treatment requires close clinical assessment, often for several years. There is evidence to suggest that clinical factors are poor indicators of patient-reported outcomes after treatments that aim to improve appearance, vision, or both. Psychosocial factors can impact on both adjustment to living with TED and also patients’ perceptions of their improvements after treatment. There has been growing recognition that it is essential to evaluate treatment efficacy in terms of psychosocial outcomes but, to date, there has been no review that has systematically evaluated psychosocial outcomes following a variety of treatments for TED. Summary: Fifteen studies were included in the review and 6 were randomized controlled trials (RCTs). The studies varied greatly in methodological rigor; whilst major treatments such as surgery do improve quality of life outcomes, other non-invasive treatments such as intravenous steroids can have a similar impact and show long-term benefits. Only 3 studies reviewed orbital decompressive surgery which showed better psychosocial outcomes than other types of surgery. Conclusions: The effect of some treatments remains unclear due to poor methodology and poor reporting of results. Clinicians need to be aware when planning rehabilitative treatments such as surgery the influence of psychosocial factors on quality of life outcomes and the lack of a relationship with clinical factors such as disease severity

Endoscopical Orbital Fat Decompression with Medial Orbital Wall Decompression for Dysthyroid Optic Neuropathy

Objective: To describe a novel approach to orbital decompression for dysthyroid optic neuropathy (DON). Methods: An augmented endoscopic transethmoid medial orbital wall decompression (ETMOWD) was performed on 43 consecutive patients (72 eyes) with DON in order to access the orbital apex adequately. Concurrently, endoscopic transethmoid fat decompression (ETFD) using a novel aspiration/cutting instrument to remove orbital fat was performed for further reduction of proptosis. All patients were followed up periodically for at least 6 months. Outcomes such as improvement of visual acuity (VA), color vision, degree of proptosis reduction as well as the incidence of surgical induced diplopia were analyzed at the final review. Results: Sixty-nine out of 72 eyes (95.8%) had a statistically significant improvement in VA from −0.65 ± 0.30 to −0.25 ± 0.22 postoperatively, with a mean improvement of 0.55 ± 0.17 (p < 0.001). Thirty-four out of 45 eyes had an improvement in color vision (p < 0.001). The range of proptosis reduction was 4 to 9 mm (mean 6.2 ± 1.2 mm). Postoperative symmetry was achieved to within 2 mm using an exophthalmometer in 39 of 43 patients (90.7%). Five patients developed diplopia in the postoperative phase, but had complete resolution within 3 months. Two patients had further deterioration in their diplopia following surgery. Conclusion: Our technique of a combined ETFD with ETMOWD appears to be effective in managing patients with DON, with minimal morbidities and a low incidence of postoperative diplopia

Endoscopic and transcaruncular medial wall decompression in unilateral graves’ orbitopathy: a multicenter randomized study

Abstract Background Thyroid eye disease is the most common orbital inflammatory disorder causing unilateral or bilateral proptosis in an adult. Infiltrative orbitopathy thyroid disease characterized by the deposition of immune complexes and inflammatory cells with subsequent fibrosis can severely affect vision and damage the optic nerve. In this study, we compare the safety and efficacy of transcaruncular versus endoscopic orbital decompression in the management of patients with unilateral Graves’ orbitopathy. Patients and methods This is a retrospective comparative, center-based randomization which included 36 eyes of 36 different patients with Graves’ orbitopathy and axial proptosis ranging between 20 and 26 mm. Complete ophthalmic examination included visual acuity, color vision, intraocular pressure, fundus examination and visual field assessment. Proptosis was measured by Hertel exophthalmometry and computed tomography orbit for all the cases preoperatively and 1.6 months postoperatively. There were follow-ups at day 1 postoperative, and at 1, 3, 6 months. All patients were photographed by the same camera. Patients were divided and were randomized on center based, distributed into two groups: the endoscopic group (18 eyes) were operated on through nasal endoscopic approach and the transcaruncular group (18 eyes) were operated on through the transcaruncular approach. Result There was significant reduction in proptosis in each group after surgery (P<0.001). The mean reduction of proptosis was more pronounced and statistically significant in the transcaruncular group (4.78±0.17 mm) as compared with the endoscopic group (3.61±0.18 mm) (P<0.001). The bony decompressed volume estimated by the serial computed tomography image was 0.75±0.23 cm3 in the transcaruncular group and 0.80±0.29 cm3 in the endoscopic group. There significant improvement in vision from 20/45 to 20/30 in both groups (P<0.001). Visual field defects have improved in 14 (77.8%) cases of the transcaruncular group, as compared with 15 (83.3%) cases of the endoscopic group with complete resolution of corneal staining in both groups within 1 month, postoperatively. Conclusion The transcaruncular technique showed better results because it has significantly better proptosis reduction, has 50% less residual proptosis, higher expanded compressed volume area and better improvement of visual acuity, although statistically nonsignificant