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Original paper
Submitted: 2021-04-14
Accepted: 2021-07-23
Published online: 2021-08-18
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Orbital decompression for thyroid eye disease: surgical treatment outcomes in endocrinological assessment

Olga Jurek-Matusiak1, Eliza Brożek-Mądry1, Helena Jastrzębska2, Antoni Krzeski1
DOI: 10.5603/EP.a2021.0078
·
Pubmed: 34647604
Affiliations
  1. Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Stepinska 19/25, 00-739 Warsaw, Poland
  2. Department of Endocrinology, Medical Center of Postgraduate Education in Warsaw, Cegłowska 80,, 01-809 Warsaw,, Poland

open access

Ahead of print
Original Paper
Submitted: 2021-04-14
Accepted: 2021-07-23
Published online: 2021-08-18

Abstract

Introduction: Surgical orbital decompression involves removal of one or more orbital bony walls in order to gain space for overgrown muscles and adipose tissue, which results in a reduction in pressure on the eye. This observational study aims to perform an endocrinological assessment of the surgical treatment outcomes of thyroid eye disease (TED) patients before and after orbital decompression. Material &Methods: This retrospective study included 51 TED patients (84 orbits) who underwent endoscopic orbital decompression (EOD) or balanced orbital decompression.The effect of surgical treatment was evaluated via the clinical activity score (CAS), modified NOSPECS and EUGOGO classification. Results: Before orbital decompression, the average CAS index was 3.83+/–1.86 points, whereas the modified NOSPECS score was 3.31+/–0.97 points. After surgical intervention, the values were as follows: 2.07+/–1.84 points for CAS and 2.5+/–0.97 points for modified NOSPECS. The EUGOGO classification before surgery showed that Graves’ orbitopathy (GO) was mild, moderate to severe and sight-threatening in 1%, 25% and 74% of the orbits, respectively. After surgery, GO was determined to be mild, moderate to severe and sight-threatening in 24%, 57% and 19% of the orbits. Statistical analysis was performed using the R 3.6.2 statistical environment. Inference about the statistical reliability of the parameter was made by calculating the mean and the 95% credibility interval (CI). Conclusions: The severity of TED decreased after orbital decompression. The CAS, modified NOSPECS and EUGOGO classification showed a statistically reliable postoperative reduction. The drop in activity of the disease after orbital surgery requires careful follow-up.

Abstract

Introduction: Surgical orbital decompression involves removal of one or more orbital bony walls in order to gain space for overgrown muscles and adipose tissue, which results in a reduction in pressure on the eye. This observational study aims to perform an endocrinological assessment of the surgical treatment outcomes of thyroid eye disease (TED) patients before and after orbital decompression. Material &Methods: This retrospective study included 51 TED patients (84 orbits) who underwent endoscopic orbital decompression (EOD) or balanced orbital decompression.The effect of surgical treatment was evaluated via the clinical activity score (CAS), modified NOSPECS and EUGOGO classification. Results: Before orbital decompression, the average CAS index was 3.83+/–1.86 points, whereas the modified NOSPECS score was 3.31+/–0.97 points. After surgical intervention, the values were as follows: 2.07+/–1.84 points for CAS and 2.5+/–0.97 points for modified NOSPECS. The EUGOGO classification before surgery showed that Graves’ orbitopathy (GO) was mild, moderate to severe and sight-threatening in 1%, 25% and 74% of the orbits, respectively. After surgery, GO was determined to be mild, moderate to severe and sight-threatening in 24%, 57% and 19% of the orbits. Statistical analysis was performed using the R 3.6.2 statistical environment. Inference about the statistical reliability of the parameter was made by calculating the mean and the 95% credibility interval (CI). Conclusions: The severity of TED decreased after orbital decompression. The CAS, modified NOSPECS and EUGOGO classification showed a statistically reliable postoperative reduction. The drop in activity of the disease after orbital surgery requires careful follow-up.

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Keywords

thyroid eye disease, orbital decompression, CAS, NOSPECS classification, EUGOGO classification

About this article
Title

Orbital decompression for thyroid eye disease: surgical treatment outcomes in endocrinological assessment

Journal

Endokrynologia Polska

Issue

Ahead of print

Article type

Original paper

Published online

2021-08-18

DOI

10.5603/EP.a2021.0078

Pubmed

34647604

Keywords

thyroid eye disease
orbital decompression
CAS
NOSPECS classification
EUGOGO classification

Authors

Olga Jurek-Matusiak
Eliza Brożek-Mądry
Helena Jastrzębska
Antoni Krzeski

References (29)
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