Deep lateral orbital decompression for Graves orbitopathy: a systematic review

Purpose To systematically review the literature on the deep lateral orbital decompression (DLD). Methods The authors searched the MEDLINE, Lilac, Scopus, and EMBASE databases for all articles in English, Spanish, and French that used as keywords the terms orbital decompression and lateral wall. Two...

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Veröffentlicht in:International ophthalmology 2021-05, Vol.41 (5), p.1929-1947
Hauptverfasser: Cruz, Antonio Augusto V., Equiterio, Bruna S. N., Cunha, Barbara S. A., Caetano, Fabiana Batista, Souza, Roque Lima
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container_end_page 1947
container_issue 5
container_start_page 1929
container_title International ophthalmology
container_volume 41
creator Cruz, Antonio Augusto V.
Equiterio, Bruna S. N.
Cunha, Barbara S. A.
Caetano, Fabiana Batista
Souza, Roque Lima
description Purpose To systematically review the literature on the deep lateral orbital decompression (DLD). Methods The authors searched the MEDLINE, Lilac, Scopus, and EMBASE databases for all articles in English, Spanish, and French that used as keywords the terms orbital decompression and lateral wall. Two articles in German were also included. Data retrieved included the number of patients and orbits operated, types of the approach employed, exophthalmometric and horizontal eye position changes, and complications. The 95% confidence intervals (CI) of the mean Hertel changes induced by the surgery were calculated from series with 15 or more data. Results Of the 204 publications initially retrieved, 131 were included. Detailed surgical techniques were analyzed from 59 articles representing 4559 procedures of 2705 patients. In 45.8% of the reports, the orbits were decompressed ab-interno. Ab-externo and rim-off techniques were used in 25.4% and 28.8% of the orbits, respectively. Mean and 95% CI intervals of Hertel changes, pooled from 15 articles, indicate that the effect of the surgery is not related to the technique and ranges from 2.5 to 4.5 mm. The rate of new onset of diplopia varied from zero to 8.6%. Several complications have been reported including dry eye, oscillopsia, temporal howling, lateral rectus damage, and bleeding. Unilateral amaurosis and subdural hematoma have been described in only one patients each. Conclusions The low rate of new-onset diplopia is the main benefit of DLD. Prospective studies are needed to compare the rate of complications induced by the 3 main surgical techniques used.
doi_str_mv 10.1007/s10792-021-01722-3
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N. ; Cunha, Barbara S. A. ; Caetano, Fabiana Batista ; Souza, Roque Lima</creator><creatorcontrib>Cruz, Antonio Augusto V. ; Equiterio, Bruna S. N. ; Cunha, Barbara S. A. ; Caetano, Fabiana Batista ; Souza, Roque Lima</creatorcontrib><description>Purpose To systematically review the literature on the deep lateral orbital decompression (DLD). Methods The authors searched the MEDLINE, Lilac, Scopus, and EMBASE databases for all articles in English, Spanish, and French that used as keywords the terms orbital decompression and lateral wall. Two articles in German were also included. Data retrieved included the number of patients and orbits operated, types of the approach employed, exophthalmometric and horizontal eye position changes, and complications. The 95% confidence intervals (CI) of the mean Hertel changes induced by the surgery were calculated from series with 15 or more data. Results Of the 204 publications initially retrieved, 131 were included. Detailed surgical techniques were analyzed from 59 articles representing 4559 procedures of 2705 patients. In 45.8% of the reports, the orbits were decompressed ab-interno. Ab-externo and rim-off techniques were used in 25.4% and 28.8% of the orbits, respectively. Mean and 95% CI intervals of Hertel changes, pooled from 15 articles, indicate that the effect of the surgery is not related to the technique and ranges from 2.5 to 4.5 mm. The rate of new onset of diplopia varied from zero to 8.6%. Several complications have been reported including dry eye, oscillopsia, temporal howling, lateral rectus damage, and bleeding. Unilateral amaurosis and subdural hematoma have been described in only one patients each. Conclusions The low rate of new-onset diplopia is the main benefit of DLD. Prospective studies are needed to compare the rate of complications induced by the 3 main surgical techniques used.</description><identifier>ISSN: 0165-5701</identifier><identifier>EISSN: 1573-2630</identifier><identifier>DOI: 10.1007/s10792-021-01722-3</identifier><identifier>PMID: 33517506</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Blindness ; Blood ; Brain ; Complications ; Confidence intervals ; Decompression ; Diplopia ; Dura mater ; Graves' disease ; Hematoma ; Literature reviews ; Medicine ; Medicine &amp; Public Health ; Meninges ; Ophthalmology ; Orbits ; Review ; Surgery ; Surgical techniques</subject><ispartof>International ophthalmology, 2021-05, Vol.41 (5), p.1929-1947</ispartof><rights>The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-4bfd2996e3563e7d389283071eedc32759e7e879f5999fb856bd9726bc9632e13</citedby><cites>FETCH-LOGICAL-c375t-4bfd2996e3563e7d389283071eedc32759e7e879f5999fb856bd9726bc9632e13</cites><orcidid>0000-0002-8972-5571</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10792-021-01722-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10792-021-01722-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33517506$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cruz, Antonio Augusto V.</creatorcontrib><creatorcontrib>Equiterio, Bruna S. 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The 95% confidence intervals (CI) of the mean Hertel changes induced by the surgery were calculated from series with 15 or more data. Results Of the 204 publications initially retrieved, 131 were included. Detailed surgical techniques were analyzed from 59 articles representing 4559 procedures of 2705 patients. In 45.8% of the reports, the orbits were decompressed ab-interno. Ab-externo and rim-off techniques were used in 25.4% and 28.8% of the orbits, respectively. Mean and 95% CI intervals of Hertel changes, pooled from 15 articles, indicate that the effect of the surgery is not related to the technique and ranges from 2.5 to 4.5 mm. The rate of new onset of diplopia varied from zero to 8.6%. Several complications have been reported including dry eye, oscillopsia, temporal howling, lateral rectus damage, and bleeding. Unilateral amaurosis and subdural hematoma have been described in only one patients each. Conclusions The low rate of new-onset diplopia is the main benefit of DLD. 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subjects Blindness
Blood
Brain
Complications
Confidence intervals
Decompression
Diplopia
Dura mater
Graves' disease
Hematoma
Literature reviews
Medicine
Medicine & Public Health
Meninges
Ophthalmology
Orbits
Review
Surgery
Surgical techniques
title Deep lateral orbital decompression for Graves orbitopathy: a systematic review
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