Br J Ophthalmol 2000;84:600-605
( June )
Reversal of dysthyroid optic neuropathy following orbital fat
decompression
Michael Kazima b, Stephen L Trokela, Golge Acaroglua, Alexandra Elliotta
a Department of
Ophthalmology, Edward S Harkness Eye Institute, Columbia-Presbyterian
Medical Center, New York, USA, b Department
of Surgery, Columbia-Presbyterian Medical Center, New York, USA
Correspondence to: Michael Kazim, MD, Edward S Harkness Eye Institute, 635 West 165th
Street, New York, NY 10032, USA
mk48{at}columbia.edu
Accepted for publication 10 January 2000
AIMS
To document the
successful treatment of five patients with dysthyroid optic neuropathy
by orbital fat decompression instead of orbital bone decompression
after failed medical therapy.
METHODSEight orbits
of five patients with dysthyroid optic neuropathy were selected for
orbital fat decompression as an alternative to bone removal
decompression. Treatment with systemic corticosteroids and/or orbital
radiotherapy was either unsuccessful or contraindicated in each case.
All patients satisfied clinical indications for orbital bone
decompression to reverse the optic neuropathy. High resolution
computerised tomographic (CT) scans were performed in all cases and in
each case showed signs of enlargement of the orbital fat compartment.
As an alternative to bone decompression, orbital fat decompression was
performed on all eight orbits.
RESULTSOrbital fat
decompression was performed on five patients (eight orbits) with optic
neuropathy. Optic neuropathy was reversed in all cases. There were no
cases of postoperative diplopia, enophthalmos, globe ptosis, or
anaesthesia. All patients were followed for a minimum of 1 year.
CONCLUSIONSIn a
subset of patients with an enlarged orbital fat compartment and in whom
extraocular muscle enlargement is not the solitary cause of optic
neuropathy, fat decompression is a surgical alternative to bony decompression.
© 2000 by British Journal of Ophthalmology
