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PubMedDate not supplied

Skew transposition of vertical rectus muscles for excyclovertical deviation.

PURPOSE: The authors established a surgical treatment for excyclovertical strabismus in which either the inferior rectus muscle or the superior rectus muscle was transposed diagonally. The effects and the safety of the procedure, called skew transposition, were studied. METHODS: Eighteen operations using local anesthesia with eye drops were performed on 17 cases, including 10 with superior oblique palsy. Diplopia was checked during the operation with the cooperation of each patient. Both the clinical findings and eye deviation were examined during observation periods. RESULTS: After the first operation, the diplopia in the primary position had disappeared in 10 cases and had improved in the other 7. The average effect of all operations on excyclodeviation was a correction of 6.2 degrees in the primary position. In the 7 cases of superior oblique palsy that received nasal recession of the inferior rectus muscle, the average correction of excyclodeviation was 6.4 degrees, and vertical deviation improved 1.8 degrees per 1 mm of recession. In no case did the diplopia worsen, nor were there any complications. CONCLUSIONS: This safe procedure facilitates the simultaneous improvement of both excyclo- and vertical deviations. It may become the treatment of choice for excyclovertical strabismus.

Adult↗
PubMed2000

Pediatric orbital floor fracture : direct extraocular muscle involvement.

OBJECTIVE: To study the clinical presentation, operative findings, and postoperative results of a surgical series of isolated orbital floor fractures in children. DESIGN: Noncomparative, retrospective, consecutive case series. PARTICIPANTS: Thirty-four patients (34 orbits) less than 18 years of age with isolated orbital floor fractures. Indications for surgery were severe limitation of extraocular ductions, 22 of 34; enophthalmos, 8 of 34: or both, 4 of 34. INTERVENTION: Surgical repair. MAIN OUTCOME MEASURES: Cause of fracture, symptoms, clinical signs, radiographic data, operative findings, postoperative results, and complications. RESULTS: Children older than 12 years of age were more likely to sustain an orbital floor fracture as a result of interpersonal violence than were children less than 12 years of age (P: = 0.020). Sixty-two percent of patients (21 of 34) exhibited pain with eye movements and/or nausea and vomiting. Most had a trapdoor type fracture (21 of 34). The inferior rectus muscle was entrapped in the orbital floor fracture in 69% (18 of 26) of patients with a severe limitation of ocular ductions. Preoperative nausea and vomiting were immediately relieved after surgery. The median time for improvement of preoperative duction deficits and diplopia was 4 days for patients receiving surgery within 7 days and 10.5 days for those undergoing surgery after 14 days (P: = 0.030). Resolution of duction deficits or diplopia was not dependent on time of surgery if performed within 1 month of injury. Loss of vision, worsening of motility, or implant complications did not occur. CONCLUSIONS: Pediatric patients with isolated orbital floor fractures who had pain, nausea, vomiting, and severe limitation of extraocular motility often have direct entrapment of the inferior rectus muscle into the fracture site. Surgical repair rapidly relieved preoperative pain, nausea, and vomiting. For patients with severe limitation of ductions, early surgical repair within 7 days of injury resulted in more rapid improvement of ductions and diplopia than surgery performed later.

Accidental Falls↗
PubMed2005

[Comparison of two surgical techniques for the treatment of superior oblique palsy].

AIM: To compare two surgical techniques for the treatment of superior oblique palsy. PATIENTS AND METHODS: Retrospective study involving 32 patients operated on at the Rouen Teaching Hospital for superior oblique palsy. Group 1 patients were treated by surgical reinforcement of the superior oblique muscle and group 2 patients were treated by surgical loosening (or weakening) of the antagonist muscles. One-year follow-up explored head tilt, diplopia, vertical deviation and cyclotorsion. RESULTS: Functional results (presence of diplopia or stiff neck) were positive in both groups but better in group 1. Only 12.5% of patients required a second operation. Cyclotorsion amounted to less than 2% in group 1 and was still greater than 8% in group 2; on the other hand, vertical deviation had improved more in group 2, where it decreased to 2.1 diopters versus 3.1 in group 1. DISCUSSION: and conclusion: Only reinforcing the superior oblique adequately corrects cyclotorsion, which is the main cause of asthenopia and diplopia, despite an often insufficient height correction that is otherwise clinically well tolerated. We suggest reinforcing the superior oblique as a first intent rather than weakening hyperactive muscles, and in case of excessive postoperative height, we would carry out additional treatment of one of the hyperactive muscles later.

Adolescent↗
PubMed1997

Topographical analysis of ablation centration after excimer laser photorefractive keratectomy and laser in situ keratomileusis for high myopia.

PURPOSE: To evaluate the ablation centration after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for high myopia and to assess the association between decentration and best corrected visual acuity (BCVA), glare, monocular diplopia, and halo phenomenon. SETTING: Mater Private Hospital, Dublin, Ireland. METHODS: Corneal topography was used to analyze centration in two groups of patients with myopia of more than 6.0 diopters: 18 had PRK and 18, LASIK. A standardized questionnaire assessed the preoperative and postoperative prevalence of glare, monocular diplopia, and halo phenomenon. RESULTS: "Significant" ablation decentration (0.5 mm) in the LASIK group (1.33 mm) was almost twice that in the PRK group (0.75 mm). Glare increased from 27% preoperatively to 42% in the PRK group; monocular diplopia increased in the LASIK group. Halo phenomenon decreased after both procedures. CONCLUSION: Laser in situ keratomileusis represents a step forward in the surgical correction of high myopia, but the accuracy of the corneal ablation location must be improved. Suction ring fixation of the globe or real time tracking systems may help improve centration.

Adult↗
PubMed2000

Results of transantral orbital decompression in patients with thyroid-associated ophthalmopathy.

PURPOSE: To present the results of orbital decompression in patients with thyroid-associated ophthalmopathy (TAO). METHODS: Transantral orbital decompression was performed in 63 patients with TAO. In 40 patients (63%) the operation was made because of progressive ophthalmopathy not responding to medical therapy, and in 23 patients (37%) the operation was made for rehabilitative reasons. The long-term hypesthesia engaging the infraorbital nerve was assessed with a questionnaire using a Visual Analogue Scale (VAS). RESULTS: The mean proptosis reduction was 3.2 mm (range 0-8 mm). Twenty-one patients had impaired visual acuity preoperatively, and 20 improved. Altogether 30 patients (40%) had worsened ocular motility postoperatively. Forty-three patients did not have diplopia in the primary position preoperatively, and new diplopia developed in 22 of these (51%). Hypesthesia in the infraorbital nerve area was reported for half of the operated sides, but was a major cause of distress (VAS-scoring >5) to eleven patients. CONCLUSIONS: Transantral orbital decompression is indicated in patients with progressive TAO or in patients with prominent exophthalmos, and results in a good proptosis reduction, but the risk of postoperative diplopia is significant. Postoperative hypesthesia is common but often not a major problem.

Adolescent↗
PubMed2002

A comparison of parietal and iliac crest bone grafts for orbital reconstruction.

PURPOSE: This study evaluated the results of cranial (membranous) versus iliac crest (endochondral) bone grafts as implants to correct post-traumatic globe malposition and/or diplopia. PATIENTS AND METHODS: Twenty-two patients underwent 25 orbital reconstructions with bone for enophthalmos, hypophthalmos, and diplopia after trauma to the orbit. Inclusion criteria consisted of at least 4 months postsurgical follow-up, pre- and postsurgical quantitative orbital measurements, photographic documentation, and complete medical records regarding inpatient and outpatient data. RESULTS: Nine cranial bone grafts and 16 iliac crest grafts were placed. Ages were similar in both groups. The average follow-up was 24 months for the cranial graft group (range, 4 to 54 months) and 18 months for the iliac crest graft group (range, 4 to 51 months). Preoperative enophthalmos averaged 4.11 and 5.06 mm in the cranial and iliac crest groups, respectively, and postoperatively the measurements were 1.78 and 1.37 mm, respectively. Changes in hypophthalmos generally reflected changes in the enophthalmos correction. In 10 patients diplopia was corrected by the procedure. There was a statistically significant change in the enophthalmos of patients when comparing pre- and postoperative status, but no statistically significant difference between the results of the cranial and iliac crest graft groups. CONCLUSION: There is no difference in the ability of cranial and iliac crest bone grafts to correct post-traumatic enophthalmos.

Adult↗
PubMed2003

Reconstruction of Sphenoid Wing Dysplasia with Pulsating Exophthalmos in a Case of Neurofibromatosis Type 1 Supported by Intraoperative Navigation Using a New Skull Reference System.

A patient with neurofibromatosis type 1 had pulsating exophthalmos of the right eye with diplopia resulting from severe dysplasia of the sphenoid bone and consecutive herniation of the right temporal lobe. The right orbital tectum was reconstructed with titanium mesh and iliac spongiosa via a lateral orbitotomy using intraoperative navigation. For intraoperative referencing a cortical fixed-reference system and a skin scanning laser device were used. Postoperatively, the diplopia was reduced, but the patient asked for further treatment and the procedure was repeated 6 months later. Intraoperatively, the previously implanted titanium mesh was deformed and most of the transplanted bone was resorbed, probably because of pressure. A more extended mesh was implanted and iliac spongiosa was placed on both sides. Intraoperative navigation was used during both procedures. The adverse effects of diplopia were minimized and follow-up computed tomography after seven months confirmed that the bone graft was in place.

Case Reports↗
PubMed2006

[Bitemporal hemianopia in road traffic].

BACKGROUND: Patients suffering from pituitary adenomas and diseases of the chiasma typically show a bitemporal hemianopia. The residual undisturbed nasal visual fields of both eyes should have an extension of (at least) 120 degrees and are according to the actual German traffic rules (FeVAndV) for cars of the classes A, B, M, L and T. The intact half fields fit geometrically to one virtual normal field, that seems to correspond in the centre of a normal field. Reports on this problem often do not address correctly the questions of suitability for participation in road traffic. PATIENTS: The case of a patient with typical bitemporal hemianopia illustrates the sensorial peculiarities: the functioning temporal retinal halves do not correspond. This patient suffered additionally from disturbing diplopia due to a small-angle exotropia. The extent of the performed eye muscle surgery was selected to induce a slight overcorrection, i. e., resulting in 3 to 5 degrees esotropia. This eliminated the diplopia, but resulted in a vertical scotoma of the extension of the esotropia. CONCLUSIONS: In bitemporal hemianopia the undisturbed nasal visual half fields do not add up to a "nearly normal field of one eye". Moreover, either diplopia or--much more dangerous in traffic--a central vertical scotoma is the result. The explanation for this is a sliding of the hemifields of each eye without stabilisation by corresponding areas of the retinas of the right and left eyes. The peripheral extension of the visual field is not the key to the problem to imagine how a patient with typical bitemporal hemianopia will visualise daily life and traffic. In bitemporal hemianopia there is substantially no eligibility for driving a car or motor bicycle in road traffic.

Adult↗
PubMed1996

[Binocular problems caused by aniseikonia and anisophoria after cataract operation].

BACKGROUND: Cataract and refractive surgery aiming at emmetropia, runs the risk to induce binocular problems, e.g. asthenopia or diplopia. If the compatibility concerning binocularity is solely estimated by the calculation of the difference of the retinal image sizes, using intraocular lens formulas or so-called "aniseikonia-programs", important physiological facts are not considered. The actual amount of the aniseikonia, this is the difference of the image size which the patient perceives subjectively, depends on 3 parameters: 1. the optically induced difference of the retinal image size, 2. the spatial density of the retinal photoreceptors and the size of the receptive fields, 3. a possibly existing anomalous retinal correspondence for different retinal image sizes. Besides aniseikonia, the induction of postoperative anisophoria by the required spectacle correction is a considerable aspect. Aniseikonia and anisophoria can cause fusional problems or diplopia because of the mentioned parameters and/or disparity of the retinal images. CASE REPORT: Cataract surgery should reduce a monolateral high myopia, aiming emmetropia, in axial anisometropia. This resulted in one exemplary case in high aniseikonia with complaints, while in other, comparable patients only a small amount of aniseikonia could be measured by haploscopy. This preoperative refractive situation is comparable to refractive surgery. In a second case with symmetrical myopia of -4 D, binocular problems with diplopia and asthenopia were induced after monolateral cataract surgery by the combination of a moderate aniseikonia and anisophoria. CONCLUSIONS: To predict the actual postoperative aniseikonia it is necessary for the patient to wear a contact lens preoperatively for a short time to measure the aniseikonia by haploscopy, particularly prior to refractive surgery in axial length ametropia. Due to the different sizes of the receptive fields of the retina, different postoperative aniseikonias may result in spite of similar axial length anisometropia. The individual tolerance of an adult for a postoperatively created anisophoria is hardly predictable. It is obvious that the fusional stress ensued from aniseikonia and anisophoria adds or multiplies. In contrast to horizontal eye movements, vertical eye movements can hardly be compensated by head movements, as the use of bi- or multifocals requires a down gaze of about 30 degrees. Here a height-balance-prism could help.

Adult↗
PubMed2001

Results of orbital decompression in Taiwan.

Orbital decompression was performed on 116 orbits with Graves' ophthalmopathy. The indications for decompression were dysthyroid optic neuropathy (DON), recalcitrant corneal exposure (EXP) and disfiguring exophthalmos (COS). All cases but one (in the DON group) had improved or unchanged vision. The average retinal sensitivity improvement in the DON group was 6.7 +/- 6.1 dB and 85% had a significant retinal sensitivity improvement (>5 dB). The average retroplacement effect was 4.4 +/- 2.1 mm and only five cases (7%) had postoperative asymmetry of more than 2 mm by Hertel's exophthalmometry. The most frequent sequela was diplopia, which tended to occur in more severely myopathic eyes. In our series, 21% (10/48 cases without preoperative diplopia) developed diplopia after decompressive surgery. Hypoglobus is another complication, noted in two cases, which was successfully repositioned. In conclusion, decompressive surgery is a safe and effective procedure to restore vision and reduce exophthalmos in Graves' ophthalmopathy. Careful evaluation of clinical parameters, individualization of surgical goals and intraoperative titration of the retroplacement effect are the key to optimal results.

Journal Article↗
PubMed2002

Modified Harada-Ito procedure in bilateral superior oblique paresis.

BACKGROUND: Patients with bilateral superior oblique palsies may complain of diplopia and torsion, especially in downgaze. They are difficult to manage surgically, although bilateral modified Harada-Ito procedures may be of value. METHODS: A retrospective review was carried out of patients treated with bilateral Fells' modified Harada-Ito procedures for bilateral superior oblique palsy between 1989 and March 2000, the patients being identified from operating records. RESULTS: Twenty-three patients were identified (9 females and 14 males) with a mean age at presentation of 37 years (range 19 to 75). In 20 cases (87%) the aetiology was trauma (14 due to traffic accidents). All patients had diplopia at presentation (3 specifically mentioned torsion) with a mean duration of 22.5 months. Eleven patients had abnormal head postures and 13 were binocular. Mean vertical deviation was 3.2(delta)for distance and 4(delta)for near. Maximum torsion ranged from 5 degrees (previous surgery) to 24 degrees excylotorsion with a mean of 13 degrees. Thirteen patients had a V pattern. After surgery the mean vertical deviation was 1.5(delta )for distance and 1(delta)for near. Ten patients were symptom free, 8 had reduced diplopia and 5 were unchanged. The worst torsion post-op ranged from 1 degrees of intorsion to 11 degrees of excyclotorsion (mean 4 degrees ). Further vertical muscle surgery was required in 10 (43%) patients. Mean follow-up was 13.5 months. CONCLUSIONS: In these patients bilateral modified Harada-Ito procedures successfully reduced torsion and decreased symptoms. Many patients require subsequent surgery to improve other aspects of their motility problem.

Adult↗
PubMed1998

Ophthalmoplegia in treated polymyalgia rheumatica and healed giant cell arteritis.

Diplopia may be a sign of giant cell arteritis (GCA). Polymyalgia rheumatica (PMR) is a systemic rheumatic inflammatory disease characterized by shoulder and hip girdle pain, and PMR can be associated in some patients with GCA. The authors report diplopia in two patients with treated PMR and biopsy-proven GCA, and review the literature on diplopia in GCA.

Journal Article↗
PubMed2005

Use of enophthalmic implants in the repair of orbital floor fractures.

INTRODUCTION: High-density porous polyethylene (Medpor) enophthalmic implants are used in patients with the sunken socket syndrome to augment the orbital volume. We have used them to improve enophthalmos and hypoglobus in the repair of large long-standing orbital floor fractures. This is the first report of enophthalmic wedge implants being used in seeing eyes to improve function and cosmesis. MATERIALS AND METHODS: Four patients had large long-standing orbital floor fractures with subsequent enlargement/expansion of the orbital volume. Indications for surgical intervention were enophthalmos (> 2 mm), hypoglobus (> 2 mm) and diplopia in primary position and downgaze. A transconjunctival approach was used to access the orbital floor and a Medpor enophthalmic wedge implant was placed postero-inferiorly to the globe and periosteum. RESULTS: Patients were followed up for a minimum of 4 to 6 months post-operatively with no complications noted. All patients achieved a good cosmetic and functional result post-operatively with resolution of their enophthalmos and hypoglobus. Diplopia in primary position was corrected with only mild residual diplopia present in extreme up-gaze. CONCLUSION: We have found enophthalmic implants useful in the surgical repair of symptomatic long-standing orbital floor fractures.

Adult↗
PubMed2005

Repair of medial orbital wall fracture: transcaruncular approach.

The aim of this paper is to demonstrate the safety and the use of the transcaruncular approach as a surgical technique for managing a medial wall fracture. This approach was used in 40 patients with a isolated medial or a combined medial and inferior orbital wall fracture between September 1998 and September 2002. A computed tomographic scan was taken before and after surgery. The ocular motility and enophthalmos were checked before and after surgery. The transcaruncular approach provided the appropriate surgical exposure in all cases. Patients were followed up for a mean of 9.4 months (range, 524 months) after repairing the orbital wall fracture. Hertel exophthalmometry showed that among the 40 patients; 24 patients showed no enophthalmos. The enophthalmos ranged from 0.51 mm in 14 patients and 1.5 mm enphthalmos was noted in 2 patients. A clinically significant enophthalmos =2 mm was not found postoperatively. Preoperatively, 12 patients (30%) had a diplopia in the primary position of the gaze and 26 patients (65%) had a diplopia within 30 degrees of the gaze. Postoperatively, all patients had an orthotropia in the primary position but 4 patients (10%) had a residual diplopia either on the lateral gaze (2 patients) or the upgaze (2 patients). There were 2 cases of an implant misplacement. The transcaruncular approach provides a safe, rapid, and cosmetically pleasing surgical approach for managing a isolated medial wall fracture. When combined with the inferior transconjunctival approach, a combined medial and inferior orbital wall fracture can be successfully repaired.

Adolescent↗
PubMed2005

Single-stage adjustable strabismus surgery under topical anesthesia and propofol.

AIM: To present our experience with single-stage adjustable strabismus surgery (SSASS) under topical anesthesia and propofol. MATERIALS AND METHODS: Sixteen patients who either had diplopia before the surgery or were at risk of developing diplopia after the surgery were selected for this operation after evaluating their tolerance for an eyelid speculum. Recession of the lateral recti, recession, resection and advancement of the medial recti, anteriorization of the inferior oblique and marginal myotomy to the superior rectus were the procedures done under topical anesthesia and propofol. The operations were done in two phases; in the first phase, the patients were sedated for 10 minutes with intravenous propofol (2 mg/kg) and the operation was done under topical anesthesia with 2% lidocaine. In the second phase, the patients were conscious and the adjustments were made. RESULTS: None of the patients complained of significant pain during the surgery. No complications occurred during and after the procedure and no patients had diplopia during the postoperative follow-up. CONCLUSIONS: Single-stage adjustable surgery is practical and avoids the risks of regional and general anesthesia. The only disadvantage is the pain that some patients experience. We found that it is feasible to use propofol for this surgery; it provides deep sedation and prevents pain from being felt during the operation, and its short elimination half-life provides rapid awakening for the adjustment phase.

Adolescent↗
PubMed2004

Prolonged visual disturbance secondary to isolated sphenoid sinus disease.

OBJECTIVES/HYPOTHESIS: The objective was to evaluate the efficacy of endoscopic sinus surgery in patients with isolated sphenoid sinus disease with visual disturbances of more than 72 hours' duration. STUDY DESIGN: Retrospective review. METHODS: A sequential series of patients with isolated sphenoid sinus disease with visual disturbances who underwent endoscopic surgery performed by the same surgeon between 1995 and 2002 were reviewed. Patients with malignant tumors were excluded from the study. Patients were evaluated preoperatively and postoperatively to record the effects of this approach on visual acuity and diplopia. RESULTS: The study population included six women and seven men with a mean age of 56.2 years (age range, 31-75 y). Eight eyes had vision loss attributable to compressive optic neuropathy (27%) and optic neuritis (27%); seven eyes with diplopia had abducens palsy (40%) and oculomotor nerve palsy (7%). Sphenoid sinus lesions included sinusitis (38%), mucocele (31%), and aspergillosis (31%). The mean interval between the onset of visual disturbances and surgery was 6.6 months (range, 3 d-3.5 y). Visual disturbances improved in 60% of the patients (P <.01). There was better improvement in diplopia than in vision loss (P <.01). The results of endoscopic sinus surgery for patients with abducens palsy and aspergillosis were excellent (83% and 80%, respectively). Optic neuritis and visual disturbances lasting for more than 6 months were regarded as poor prognostic factors. CONCLUSION: The study supports the treatment of visual disturbances resulting from isolated sphenoid sinus disease by endoscopic sinus surgery. A timely operation may prevent permanent sequelae.

Abducens Nerve Diseases↗
PubMed2003

Errors of binocular fixation are common in normal subjects during natural conditions.

PURPOSE: To investigate the accuracy of fixation after symmetrical vergence eye movements along the midline during natural full-field viewing conditions using a video method of eye position measurement. METHODS: The accuracy of binocular fixation after symmetrical vergence eye movements during natural conditions was measured on 29 young adults using a precise head-mounted video eye movement measuring system. All subjects had normal binocular vision and good visual acuity. Measurements were taken for both near and far fixation after vergence changes of 5 degrees, 10 degrees, and 15 degrees using three rates of change, approximately 0.25, 0.5, and 1 Hz. RESULTS: The amplitude of the vergence movement tended to be hypometric, resulting in underconvergence for near fixations, and overconvergence for distance fixation. For far fixations, most errors (82%) were from -120 to +120 min arc, and for near, most errors (85%) were from -30 to +120 min arc. For far fixations, there was a significant effect of the size of vergence change (F1,28 = 61.8; p < 0.001), the rate of change (F1,28 = 7.08; p = 0.013), and the interaction between these two factors (F1,28 = 7.17; p = 0.012) on resulting errors, with the eyes showing greater overconvergence on the target for the larger and faster fixation changes. For near fixations, there was a significant effect (F1,28 = 15.9; p < 0.001) for the angle of change with the faster vergence changes producing relatively more convergence, thus reducing the mean vergence error. No subject reported diplopia during any conditions despite our measures showing vergence errors of up to 5 degrees. CONCLUSIONS: Vergence errors of up to +/-2 degrees, without diplopia, were common in subjects with normal binocular single vision. Errors of 5 degrees were rare but present. In all, the largest number of errors occurred as a failure of divergence for far fixations, consistent with previous studies that have suggested differences in the neural control of pathways for convergence and divergence, or possibly caused by differences in the anatomical properties of the medial and lateral rectus muscles and their associated fascia. The absence of diplopia during the period of fixation could only be partly associated with the visual suppression associated with vergence eye movements that has been reported by others because it was still present after the vergence movement was completed. The natural viewing conditions in this study that included a full visual field and multiple disparities may have contributed to this effect.

Adolescent↗
PubMed2001

Rationale of treatment in Graves ophthalmopathy.

Graves ophthalmopathy is a chronic and multisystem disorder caused by an autoimmune process, characterized by the presence of antibodies that stimulate a general fibroblastic reaction (thyroid gland and lower extremities), and involves orbital fat tissue and muscles. The clinical findings and therapy for the treatment of the exophthalmos, such as changes in extrinsic eye motility, diplopia, optic nerve involvement, and lid retraction, were analyzed, and the various types of surgical treatment currently available for Graves ophthalmopathy were evaluated. The aim was to choose the best option to treat each case. The surgical techniques were transpalpebral decompression by removal of intraorbital fat, three-wall osseous expansion, and zygomatic osteotomy. Adjunctive procedures were lengthening of the levator muscle of the upper eyelid, lengthening of the retractor of the lower eyelid (if necessary), and surgery of the extrinsic muscles to correct diplopia. All these techniques were useful in treating the disease, which is characterized by chronic evolution and, at times, a "malignant" outcome. A total of 39 orbits were treated using different techniques of decompression and secondary adjunctive procedures. Results were analyzed after a minimum 6-month follow-up. It was evident that surgery greatly reduced the degree of exophthalmos and improved eye motility, diplopia, and visual acuity. Close cooperation among a team of specialists, including an endocrinologist, ophthalmologist, neuroradiologist, surgeon, anesthesiologist, and radiotherapist, is essential to manage and to quantify the postoperative results of this complex disorder. The authors' experience and application of different surgical strategies, as based on clinical data and histopathological classification, are presented.

Adult↗