Prezentare Congres Stud Oftalmopatie Basedowiana

7/31/2019 Prezentare Congres Stud Oftalmopatie Basedowiana

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University of Medicine and Pharmacy Gr. T. Popa Iasi

Faculty of Medicine

Discipline of Endocrinology

Surgery for Graves' Ophthalmopathy:when and what for? The experience of Iasi

Coordinators:

M.D.PhD Dumitru Branisteanu

M.D.Victor Costan

Author:Iftime Ionica-Lidia

Co-authors:Costinescu Nicoleta-

Ramona, Gorgan Lavinia-Andreea,

Luca Irina


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Introduction:

DD Brniteanu MD PhD ( KU Leuven)

IL4

Th2

B

IL2

IFNg

TcTh1

Th1


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Introduction:

Early symptoms and signs:

a sense of irritation in the eyes;

excessive tearing;

the conjunctivae injected; exophthalmos;

lagophthalmos;

periorbital edema;

blurred vision and easy tiring ofthe eyes;

double vision.


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Introduction:

Severe cases:

color vision and visual acuitydecreased or lost;

the corneas may ulcerate orbecome infected.

Extreme orbitopathy:

subluxation of the globe;

blindness;

visual field defects.


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Introduction:

Indications for orbital decompression:

if glucocorticoid therapy or external radiation (or both) does not halt

progression of the disease if loss of vision is threatened by: -ulceration

-infection of the cornea

-changes in the retina or optic nerve

at patients request (in some patients, desire for a nearly completecosmetic correction may be such that decompression surgery is the onlysatisfactory route)


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Material and method:

18 patients

Phase of ophthalmopathy:

-one of this patients was an emergency case (malignantexophtalmos)

-the other 17 were operated in the chronic phase ofophthalmopathy

Forms of ophthalmopathy:

-13 patients were operated for proptosis

-5 patients were operated for diplopia


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Material and method:

Approach for orbital decompression:

- 15 patients- Inferior and superior transpalpebral approach

- 3 patients -Transconjunctival approach

Lipectomy:

- 5 patients-removal of both intraconal and extraconal fat

- 13 patients -only extraconal fat

All patients with the entire floor of the orbit removed weresubmitted to anaesthesia of the infraorbitary nerve territory.


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Results:

Proptosis: was decreased in all patients with at least 1 mm byHertels exophtalmometry.

Diplopia: patients without initial diplopia described transient diplopia in the

first postoperatory week;

patients who presented diplopia before surgery have noticed

significant improvement or even disappearance afterdecompression.


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Clinical case no. 1:Emergency intervention in a patient with right malignant ophthalmopathy and zerovisual acuity in the acute phase.

Dr. V Costan

a. Before surgery.b. One year after removalof the inferior and internalorbital walls and extraconalfat in the affected eye.

c. Four months afterremoval of the external walland more extraconal fat.


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Patient thyroidectomized for Gravesdisease and thyroid papillary carcinomahaving bilateral exophthalmos in the stablechronic phase, accompanied by milddiplopia and palpebral incompetence (leftpanel).

Clinical case no. 2:

Patient was submitted to bilateral surgicaldecompression (removal of extraconal fattissue through inferior and superiortranspalpebral intervention, and removal of

the orbit floor.) One year after surgery, thepatient had diminished bilateralexophthalmos, with the disappearance ofdiplopia and of palpebral incompetence(right panel).


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Two years after surgery, diplopia disappearedand the intervention scars became almostinvisible, but a certain degree of superior eyelidretraction persisted.

Graves ophthalmopathy - diplopia withrestriction of eye movements and bilateralsuperior eyelid retraction


Bilateral orbit decompression through removalof the orbit floor and superior and inferiortranspalpebral removal of extraconal fat.

The injection of botulinic toxin in the superioreyelid levator completely normalized superioreyelid positions one week after injection

Dr. V Costan


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Patient with bilateral Graves ophthalmopathy

and shortening of the right inferior eyelid 16

months after decompression surgery (upper

image), submitted to eyelid lengthening with

hard palate mucosal graft (lower image).


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Discussion:

The experience of Iasi suggests that the combination

between lipectomy and orbital wall removal adaptedto the clinical modifications and radiological features

lead to better results, since it allows a more efficient

individual adaptation.


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Conclusions:

From the experience of Iasi we conclude that orbit

surgery in the chronic phase of Graves ophthalmopathy

is preferred for:

Its predictable results

Its reduced rate of complications

The improvement of the quality of life


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Thank you!

Prezentare Congres Stud Oftalmopatie Basedowiana

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