Abstract
Objective
1) To delineate useful criteria when choosing between different techniques for orbital decompression. 2) To discuss indications and limits of the medial wall only approach.
Methods
A retrospective analysis was made of the medical charts of 256 patients operated on by a single surgeon from 1998 to 2006. 228 patients were operated on using a balanced technique, 17 by an inferomedial decompression, 11 by a medial decompression. Patients operated on by the medial wall removal had a mild to moderate proptosis, and a slight involvement of the extraocular muscles in the disease.
Results
Mean proptosis reduction was 4 mm with the inferomedial approach, 5.5 mm with the balanced procedure, and 2.6 mm with the medial wall removal. Postoperative deterioration or new onset of diplopia was 29% after inferomedial orbital decompression, 17.1% after balanced decompression, and 9% after medial wall removal.
Conclusions
When a proptosis reduction of less than 3 mm is needed, the medial wall approach is suggested. When a greater proptosis reduction is needed, a balanced decompression is advisable, since the inferomedial approach carries with it a higher risk of postoperative diplopia.
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