Search Results (37)

Background and Objectives: Graves’ orbitopathy (GO) is an autoimmune disease that can cause severe visual dysfunction and cosmetic impairment. Pure endoscopic orbital decompression reduces proptosis with minimal external morbidity. However, studies integrating both objective outcomes and patient-reported quality of life remain limited. This study aimed to analyze objective and subjective outcomes of pure endoscopic orbital decompression in inactive GO. Materials and Methods: We retrospectively reviewed 20 consecutive patients with severe inactive GO who underwent pure endoscopic transnasal orbital decompression between 2020 and 2023. Proptosis was measured using Hertel exophthalmometry, and quality of life was assessed with the disease-specific GO-QoL (Graves’ Ophthalmopathy Quality of Life) questionnaire (functional and appearance subscales). Minimum follow-up was 12 months. Pre- and postoperative changes were compared using paired t tests. Results: A total of 26 orbits were operated on. Mean proptosis decreased by 3.85 mm (p < 0.001). GO-QoL improved in the functional (+3.27, p < 0.001) and appearance (+5.77, p < 0.001) subscales. No complications or new/worsened diplopia were observed. Conclusions: Pure endoscopic orbital decompression is a safe and effective technique to reduce proptosis in inactive GO. Although quality-of-life scores improved significantly, the clinical relevance may vary, highlighting the need to integrate objective outcomes and patient perception when evaluating surgical results. Full article

Graves’ orbitopathy (GO) is a debilitating autoimmune disorder that may require surgical orbital decompression in severe cases with risk of proptosis and optic neuropathy. This report presents a case treated with navigation-assisted three-wall orbital decompression, planned with preoperative imaging and assessed using postoperative analysis. Intraoperative navigation enabled precise localization of critical structures, improving osteotomy execution. Postoperatively, orbital volume increased by 3.5 cm³ (right eye) and 4.0 cm³ (left eye), while proptosis was reduced by 6 mm in both eyes. These changes correlated with intraocular pressure normalization and functional improvement. This was further supported by a postoperative Clinical Activity Score (CAS) of 0, indicating active orbital inflammation. Image-guided surgery (IGS) achieved an average proptosis reduction of 3.8 mm, slightly superior to that of non-guided techniques. Although IGS enhances precision and functional outcomes, it requires longer surgical time and incurs higher costs, highlighting the need for prospective studies on long-term efficacy This case supports the importance of integrating advanced imaging and navigation-assisted techniques in GO management to improve both functional and aesthetic outcomes. Full article

Background and Objectives: Robotic surgery represents one of the most significant innovations in the field of surgery, offering new opportunities for the treatment of complex pathologies that require greater accuracy and precision. It is a technology that has become widely used in general, urologic, gynecologic, and cardio-thoracic surgery, but has a limited evidence in the head and neck region. This review explores the use of robotic surgery in orbital pathology, focusing on its applications, benefits, and limitations. Materials and Methods: A cross-sectional search method was performed in multiple databases to answer the following question: “What are the applications of robotic surgery in the management of orbital pathologies?” Studies were carefully reviewed by two simultaneous researchers, and, in case of disagreement, a third researcher was engaged. Care was taken to identify the surgical hardware (robotic station) used to perform the surgical procedure. Results: Out of 491 records, eight studies met the inclusion criteria. These included cadaveric, preclinical, in vitro, and early clinical investigations assessing robotic approaches for fronto-orbital advancement, tumor resection, orbital decompression, and other surgical procedures such as lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. The robotic systems evaluated included the Da Vinci Xi, Da Vinci SP, Medineering Robotic Endoscope Guiding System, and a modular multi-arm concentric tube robot, each with specific advantages and limitations. Conclusions: Robotic surgery provides significant advantages for orbital pathologies such as improved precision, visualization, and tissue preservation, with reduced complications and faster recovery, although some limitations still exist. Future advancements, such as smaller instruments and AI integration, promise to improve outcomes, making robotic surgery more effective in treating orbital conditions. Full article

Dysthyroid optic neuropathy (DON) represents a severe ocular complication in thyroid eye disease (TED) that can lead to vision loss. Although surgical decompression is a well-established treatment modality, the optimal decompression area remains controversial in orbital decompression surgery. Purpose: This study aims to develop and validate a finite element analysis (FEA) model of DON to compare the biomechanical behavior between patients undergoing conventional or augmented orbital decompression surgery, with potential clinical implications for surgical planning. Methods: FEA models were established using magnetic resonance imaging data from patients with myopathic TED. Pre-disease, preoperative, and postoperative FEA models were developed for both the conventional orbital decompression group and the augmented group, in which the posteromedial floor and the orbital process of the palatine bone were additionally removed to analyze the stress distribution and displacement of the optic nerve, eyeball, and orbital wall. A retrospective analysis was performed to validate the biomechanical analysis results. Results: The FEA results reveal that DON patients experience higher stress on the optic nerve, eyeball, and orbital wall than healthy individuals, mainly concentrated at the orbital apex. Postoperatively, the stress on the optic nerve was significantly reduced in both groups. In addition, postoperative stress on the optic nerve was significantly lower in the augmented group than in the conventional group. The clinical results demonstrate that patients in the augmented group experienced significantly faster and more pronounced improvements in visual acuity and visual field. Conclusions: FEA shows that augmented orbital decompression surgery can alleviate stress more effectively, especially for the optic nerve, which was validated by clinical analysis. This developed FEA model of DON may facilitate determining the appropriate surgical procedure for orbital decompression. Full article

Objective: Various orbital conditions (trauma, autoimmune thyroid disease, tumors, infections, congenital malformations) may lead to a consecutive increase in orbital cavity pressure resulting in orbital compartment syndrome (OCS). OCS is associated with acute loss of visual function and a high risk of permanent damage to the optic nerve (compressive optic neuropathy). Orbital decompression surgery (ODS) is a time-critical procedure that reduces pressure on the optic nerve, thereby improving visual function. The surgical management protocol for orbital decompression is not standardized and varies. Surgical techniques differ in orbital fat decompression, lateral canthotomy, and decompression of the medial orbital wall and floor. This retrospective study aims to evaluate surgery procedures and the outcome of visual function after orbital decompression surgery. Methods: In this retrospective study, we evaluated 28 patients (17 male, 11 female) with orbital compartment syndrome from May 2016 to October 2024. All patients underwent orbital decompression surgery as first-line treatment. Visual acuity (VA), diplopia, and ocular motility were analyzed pre- and postoperatively. Recovery was defined as postoperative improvement of vision, diplopia, and ocular motility. Linear and logistic regression analyses were used to assess the associations between clinically relevant risk factors and primary outcomes. Results: Orbital decompression surgery was performed with a median of 8.40 h (Q1: 4.80, Q3: 24.00) upon occurrence of symptoms. The average preoperative measured VA (logMAR) of the affected eye was 1.0. A total of 46% of the patients were preoperatively categorized as ”blind“ according to the WHO visual impairment categories. A total of 96% of the patients showed preoperative ocular motility impairment. Diplopia was preoperatively present in 46% of the patients. After orbital decompression surgery, postoperative visual acuity improved in 36% of the patients. Ocular motility improved by 67% and diplopia by 62% after ODS. The primary surgery technique was two-wall decompression in 68% (19/28) of the cases, followed by one-wall decompression (21%; 6/28), and three-wall decompression (11%; 3/28). Lateral decompression (82%; 23/28) and medial wall decompression (93%; 26/28) were the primary procedures performed. Orbital floor wall decompression was performed in only 14% (4/28) of the cases. Regression analysis revealed a statistically significant effect of preoperative measured vision on postoperative vision, while accounting for age, sex, and time to surgery. Conclusions: Orbital decompression surgery is the time-sensitive first-line treatment of acute visual function loss in OCS. Our data showed a postoperative improvement in visual acuity in 36% of the patients, along with considerable improvement rates in diplopia and ocular motility. The primary surgery technique was a two-wall decompression approach with lateral wall decompression and medial wall decompression. Center-specific timeline optimization of OCS patients is essential. Full article

Background and Objectives: The purpose of this study was to evaluate the outcome of lateral rectus (LR) muscle resection for new-onset or worsening esotropia after medial orbital wall decompression in patients with thyroid eye disease. Materials and Methods: This retrospective observational study included 20 patients. Preoperative and postoperative measurements of ocular deviation angles and fields of binocular single vision (BSV) were performed one day before and three months after surgery. Surgical success was defined as postoperative horizontal ocular deviation ≤ 5° and BSV including the primary position. Factors influencing a reduction in the esodeviation angle were analyzed using univariate and multivariate linear regression analyses. Results: Eighteen patients (90.0%) were deemed as successful surgical cases. The esodeviation angle decreased from 19.4 ± 11.2° to 1.0 ± 2.6°. In multivariate analysis, a reduction in the esodeviation angle was correlated with the presence of dysthyroid optic neuropathy (p = 0.027), amounts of LR muscle resection in mild eyes (p = 0.014), and amounts of additional medial rectus muscle recession in severe eyes (p < 0.001). Conclusions: LR muscle resection showed a high success rate in correcting new-onset or worsening esotropia which developed after medial orbital wall decompression. Several factors influencing a reduction in the esodeviation angle were found. Full article

Graves’ ophthalmopathy is the most common extrathyroidal manifestation of Graves–Basedow disease. Radiotherapy is effective especially when used in synergy with the administration of glucocorticoids. The aim of our study was to analyze the effectiveness and safety of radiotherapy, using different protocols, to improve ocular symptoms and quality of life. Methods: We retrospectively analyzed the clinical data of two-hundred and three patients treated with retrobulbar radiotherapy between January 2002 and June 2023. Ninety-nine patients were treated with a schedule of 10 Gy in 10 fractions and one-hundred and four were treated with 10 Gy in 5 fractions. Radiotherapy (RT) was administrated during the 12 weeks of pulse steroid therapy. Patients were evaluated with a clinical exam, orbital CT, thyroid assessment, and Clinical Activity Score (CAS). Results: The median follow-up was 28.6 months (range 12–240). Complete response was found in ninety-four pts (46.31%), partial response or stabilization in one hundred pts (49.26%), and progression in nine pts (4.43%). In most subjects, an improvement in visual acuity and a reduction in CAS of at least 2 points and proptosis by more than 3 mm were observed. Three patients needed decompressive surgery after treatment. Only G1 and G2 acute eye disorders and no cases of xerophthalmia or cataract were assessed. Conclusions: RT is an effective and well-tolerated treatment in this setting, especially when associated with the administration of glucocorticoids. Although the most used fractionation schedule in the literature is 20 Gy in 10 fractions, in our clinical practice, we have achieved comparable results with 10 Gy in 5 or 10 fractions with a lower incidence of toxicity. Full article

Thyroid eye disease (TED) is a common extrathyroidal manifestation of hyperthyroidism, typically associated with Graves’ disease (GD). This condition can cause severe functional limitations as well as significant aesthetic concerns. Treatment for TED patients aims to restore functionality and address aesthetic concerns. Surgical TED treatment is usually performed by orbital wall resection, which effectively decompresses intraorbital tissues and corrects the orbital/ocular disorders. Several different scenarios of surgical TED treatment including one-, two-, and three-wall resections are known. More recently, a new minimally invasive technique, the so-called lateral valgization (LAVA) of the orbital wall, was reported to show promising results comparable to conventional wall resection techniques. Due to the relatively limited data on TED treatment, only a few quantitative investigations of alternative TED surgery scenarios exist. In this feasibility study, we estimate the soft tissue outcome of LAVA treatment using computational simulation. Our experimental results show that the amount of intraorbital tissue released into the extraorbital space by LAVA treatment is comparable with the outcome of two-wall resection. Our computational simulation confirms previously reported isolated clinical findings suggesting that the minimally invasive LAVA approach represents an attractive alternative to conventional wall resection approaches for surgical TED treatment. Full article

The Apollo basin is a well-preserved double-ringed impact basin located on the northeastern edge of the South Pole–Aitken (SPA) basin. The Apollo basin has been flooded and filled with large volumes of mare lavas, indicating an active volcanism history. Based on orbital data, we reveal that the Apollo basin exhibits an overall asymmetric configuration in the distribution of mare basalts as well as its topography, chemical compositions, and crustal thickness. The Apollo basin is an excellent example for assessing the influences of the above factors on mare basalts petrogenesis and evaluating mare basalt genesis models. It was found that the generation of mare basalt magmas and their emplacement in the Apollo basin seems to be strongly related to local thin crust (<30 km), but the formation of basaltic magmas should be independent of the decompression melting because the mare units (3.34–1.79 Ga) are much younger than the pre-Nectarian Apollo basin. The mare basalts filled in the Apollo basin exhibits a large variation of TiO₂ abundances, indicating the heterogeneity of mantle sources, which is possible due to the lunar mantle overturn after the LMO solidification or the impact-induced mantle convection and migration. However, the prolonged mare volcanic history of the Apollo basin is not well explained, especially considering the low Th abundance (<2 ppm) of this region. In addition, the central mare erupted earlier than other mare units within the Apollo basin, which seems to contradict the predictions of the postbasin loading-induced stresses model. Laboratory investigations of the Chang’E-6 mare basalt samples could possibly answer the above questions and provide new insight into the mare volcanic history of the lunar farside and the connections between mare volcanism and impact basin formation/evolution. Full article

Background: Bleeding within the orbit in the form of a subperiosteal or retrobulbar hematoma is a relatively common complication of trauma and surgery. It affects up to 30% of patients fractures involving the orbital bones. Most cases do not require surgical intervention because they do not cause retinal ischemia or optic nerve neuropathy. The above symptoms occur in only 0.5–1% of patients developing Orbital Compartment Syndrome (OCS). Due to the short period (60–100 min) of time in which the optic nerve and retina can tolerate increased intraocular pressure, it seemed reasonable to evaluate and standardize the surgical management protocol for this rare complication. Objective: The aim of this retrospective study was to retrospectively analyze cases of inframammary haematomas with clinically relevant correlations. Methods: Eighteen patients treated at the Department of Maxillofacial Surgery due to OCS, in Lodz and Poznan, Poland, between 2009 and 2022, were included. APTT, INR, systemic diseases, cause, location and size of hematoma, presence and number of fractures, visual disturbances and pupillary response on the day after surgery and one month after, the type of intervention and time between admission to the hospital and surgery were evaluated. Results: Statistically significant correlations were obtained between the size of the hematoma and the patients’ age, the degree of visual disturbance and the weakening of pupillary constriction, severe initial symptoms and poor postoperative outcomes at both postoperative periods studied, immediate and distant poor outcome after decompression surgery and good postoperative outcome persisting one month after. Conclusions: The results obtained in the study and the surgical protocol proposed by the authors are in line with the current state of knowledge regarding orbital hematomas. Some of the correlations described in the literature (such as OCS and anticoagulant treatment) were not demonstrated, but this is probably due to the small study group. Maintaining the 100 min limit as a standard was possible only in early postoperative diagnoses (only 1 of the patients was operated on up to 100 min after the appearance of symptoms). In other cases, the specialized diagnosis took an average of 2785 ± 4020 min or 46 ± 67 h. Full article

Thyroid Eye Disease (TED) is a debilitating autoimmune condition often associated with thyroid dysfunction, leading to significant ocular and orbital morbidity. This review explores recent advancements in the management of TED, focusing on both medical and surgical innovations. The introduction of Teprotumumab, the first FDA-approved drug specifically for TED, marks a pivotal development in medical therapy. Teprotumumab targets the insulin-like growth factor-1 receptor (IGF-1R), effectively reducing inflammation and tissue remodeling. Clinical trials demonstrate its efficacy in reducing proptosis and improving quality of life, making it a cornerstone in the treatment of active, moderate-to-severe TED. Surgical management remains critical for patients with chronic TED or those unresponsive to medical therapy. Advancements in orbital decompression surgery, including image-guided and minimally invasive techniques, offer improved outcomes and reduced complications. Innovations in eyelid and strabismus surgery enhance functional and cosmetic results, further improving patient satisfaction. The management of TED necessitates a multidisciplinary approach involving endocrinologists, ophthalmologists, oculoplastic surgeons, radiologists, and other specialists. This collaborative strategy ensures comprehensive care, addressing the diverse aspects of TED from thyroid dysfunction to ocular health and psychological well-being. Future directions in TED treatment include emerging pharmacological therapies targeting different aspects of the disease’s pathophysiology and advanced surgical techniques aimed at enhancing precision and safety. This review underscores the importance of a personalized, multidisciplinary approach in managing TED, highlighting current advancements, and exploring potential future innovations to improve patient outcomes and quality of life. Full article

Objective: To clarify the therapy response in orbital inflammatory diseases (OID), we analyzed the treatment effects of steroid therapy, the use of disease-modifying antirheumatic drugs (DMARDS), and biologicals in our tertiary referral center cohort. Methods: We collected the clinical and demographic data of all patients treated for non-specific orbital inflammation (NSOI) (n = 111) and IgG4-ROD (n = 13), respectively at our center from 2008 to 2020 and analyzed them with descriptive statistics. NSOI were sub-grouped according to the location into either idiopathic dacryoadenitis (DAs) (n = 78) or typical idiopathic orbital myositis (n = 32). Results: Mean age at first clinical manifestation was significantly different between subgroups (IOI: 49.5 ± 18, IgG4-ROD: 63.2 ± 14, p = 0.0171). Among all examined OID, 63 patients (50%) achieved full remission (FR) with corticosteroids (NSOI 53%/IgG4-ROD 31%). In contrast, classic myositis showed a significantly higher response (76%). Disease-modifying drugs (DMARDS) for myositis accomplished only 33% FR (NSOI 57%) and 66% did not respond sufficiently (NSOI 43%). The biologic agent (Rituximab) was significantly more efficient: 19 of 23 patients (82%) achieved full remission and only 4 (17%) did not respond fully and needed orbital irradiation or orbital decompressive surgery. Full article

Purpose: Graves’ orbitopathy (GO) is an autoimmune disorder leading to inflammation, adipogenesis, and fibrosis. The severity of GO can vary widely among individuals, making it challenging to predict the natural course of the disease accurately, which is important for tailoring the treatment approach to the individual patient. The aim of this study was to compare the clinical characteristics, course, treatment, and prognosis of GO patients under 50 years with older patients. Methods: We reviewed the medical records of a random sample of 1000 patients in our GO database Essen (GODE) comprising 4260 patients at our tertiary referral center. Patients were divided into two groups: Group 1 (≤50 years) and Group 2 (>50 years). Only patients with a complete data set were included in the further statistical analysis. Results: The results showed that younger patients (n = 484) presented significantly more often with mild GO (53% vs. 33%, p < 0.0001), while older patients (n = 448) were more likely to experience moderate-to-severe disease (44% vs. 64%, p < 0.0001). Older patients showed more severe strabismus, motility, and clinical activity scores (5.9 vs. 2.3 PD/310° vs. 330° both p < 0.0001, CAS: 2.1 vs. 1.7, p = 0.001). Proptosis and occurrence of dysthyroid optic neuropathy (DON) showed no significant difference between groups (both 3%). Multiple logistic regression revealed that the need for a second step of eye muscle surgery was most strongly associated with prior decompression (OR = 0.12, 95% CI: 0.1–0.2, p < 0.0001) followed by orbital irradiation and age. The model showed good fitness regarding the area under the curve (AUC = 0.83). Discussion: In conclusion, younger GO patients present with milder clinical features such as a lower rate of restrictive motility disorders and less pronounced inflammatory signs. Therefore, older patients tend to need more steroids, irradiation, and lid and eye muscle surgery. Still, the risk of DON and the necessity of secondary eye muscle surgery are not or only slightly associated with age, respectively. Full article

Background: The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. Methods: Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. Results: A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. Conclusions: TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches. Full article

This paper presents a literature review and a case of an 83-year-old otherwise healthy female patient with a history of recent syncope, a sudden-onset right-sided temporal headache, diplopia, and vision loss. An exam revealed right-sided upper eyelid ptosis, myosis, vision loss, ophthalmoplegia, and a positive relative afferent pupillary defect on the right eye. CT showed sphenoid sinus opacification, eroded lateral sinus wall, Vidian canal, disease extension to the posterior ethmoid air cells, orbital apex, medial orbital wall, and pterygopalatine fossa. An orbital apex syndrome (Jacod’s syndrome), Horner syndrome, and pterygopalatine fossa infection were diagnosed due to the acute invasive fungal sinusitis developed from a sphenoid sinus fungal ball. The patient was treated with antimicrobial therapy and transnasal endoscopic surgery twice to decompress the orbital apex, drain the abscess and obtain specimens for analysis. The right-sided ptosis, visual loss, ophthalmoplegia, and headache resolved entirely. No immune or comorbid diseases were identified, microbiological and histopathological analyses were negative, and MRI could not be performed on the presented patient. For that reason, the diagnostic procedure was non-standard. Nevertheless, the treatment outcome of this vision and life-threatening disease was satisfactory. Treating the fungal ball in an older or immunocompromised patient is essential to prevent invasive fungal rhinosinusitis and fatal complications. Full article