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A novel method for measuring outcome of orbital decompression in Graves’ orbitopathy
Author(s) -
Baldeschi L.
Publication year - 2015
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2015.0281
Subject(s) - medicine , exophthalmos , diplopia , surgery , orbit (dynamics) , decompression , cohort , retrospective cohort study , lagophthalmos , eyelid , engineering , aerospace engineering
Summary To evaluate the outcome of a graded bone removal rehabilitative infero‐medial orbital decompression in Graves’ orbitopathy ( GO ) by means of a novel stratified appraisal ( NSA ) versus the traditional group analysis ( TGA ). This retrospective follow‐up study included all the orbits decompressed (06/1999–12/2005), at the Department of Ophthalmology University of Amsterdam by one surgeon (L.B.), using the technique under evaluation. NSA assessed or quantified: (i) the invasiveness of surgery, allowing to calculate a mean index of invasiveness per orbit ( MIIO ) and per patient ( MIIP ) (25% ≤ values ≤ 100%); (ii) at ≥ 6 months postoperatively surgical targets (desired exophthalmos reduction, improvement of retroocular tension, reduction of peri‐orbital puffiness, resolution of lagophthalmos) were scored as achieved or not allowing to calculate a mean index of targets achieved per orbit ( MITAO ) and per patient ( MITAP ) (0 ≤ values ≤ 1); (iii) an index of diplopia ( ID ) (decompression‐induced / decompressio‐cured diplopia); (iv) demographics and preoperative characteristics were compared after stratification of the included orbits for surgical target; surgical outcomes were assessed after stratification for amount of desired exophthalmos reduction and invasiveness of surgery. TGA examined the entire series as a single homogeneous cohort independently of the different targets and invasiveness of surgery. NSA and TGA were compared and complications noted. 151 orbits of 84 patients (78% female, mean age 45.5 ± 9.7 years) were included. The NSA detected differences among groups within the studied cohort, the overall achievement of surgical targets was high, indices precisely quantified the extent of applied surgery and surgical results, at variance with results obtained with TGA . A negligible complication rate was recorded. The NSA may represent a step forward towards a more comprehensive and accurate evaluation of decompression surgery outcomes.