97th DOG Annual Meeting 1999
A NEW METHOD OF MINIMAL INVASIVE ORBITAL DECOMPRESSION IN ENDOCRINE ORBITOPATHY (EO)
R. Gockeln1, R. Winter1, U. Kretschmann1, S. Hussein2
The surgial decompression of the orbit can be taken into consideration as a suitable kind of therapy if, as a result of the increase of volume inside the orbit, there are motility disorders including diplopia or a progressive decrease in visual acuity. In view of the fact that this kind of operation won't heal the underlying disease, the treatment should be as gentle as possible.
Methods: In two patients with EO we managed to extend the volume of the intraconal orbit by microsurgical liposuction. We carried out a lateral canthotomy followed by cantholysis to get into the orbit. After the decompression of the soft tissue the lateral palpebral ligament and the lateral bulbar retinaculum were refixed. To assess the scale of the functional rehabilitation we compared preoperative parameters (visual acuity, Hertel's index, motility) with postoperative results.
Results: In both cases we found a significant improvement of position and motility without any signs of diplopia. The postoperative increase of the visual acuity was 0.3 and the protrusion of the bulb could be decreased by 3-4 mm (Hertel's index). Furthermore the ocular hypertension we found preoperatively could not be proved anymore after the operation.
Summary: The microsurgical lateral canthotomy combined with cantholysis proved to be a very gentle alternative to conventional methods of orbital decompression because of the satisfying functional and aesthetic rehabilitation in selected cases.
1Dept. of Ophthalmology, Hannover Medical School, Hannover,
2Dept. of Neurosurgery, Hannover Medical School, Hannover