Preoperative Risk Factors Influencing Orbital Decompression Surgery Outcomes for Thyroid Eye Disease

Background: Orbital decompression for thyroid eye disease is an established treatment for reducing proptosis, significantly improving eye exposure and aesthetics. Existing literature has mostly sought to determine average proptosis improvement via various surgical techniques, but individual outcomes vary and are challenging to predict. Few studies have extensively investigated potential factors leading to improved or poorer individual surgical outcomes.

Aim: We seek to uncover risk factors that influence orbital decompression outcomes, specifically whether tobacco use (historical or active), body mass index, diabetes management, prior orbital radiation, prior Tepezza treatment, orbital wall/inferior rectus measurements, thyrotropin receptor antibody (TrAb) and/or thyroid stimulating antibody (TSI) levels at the time of surgery influence proptosis improvement, measured via Hertel exophthalmometry.

Methods: We are conducting a retrospective chart review of 205 patients who underwent orbital decompression for Grave’s orbitopathy. Patient demographics, concomitant illnesses, diabetes status, tobacco usage, BMI, orbital radiation history, Tepezza history, and orbital wall and inferior rectus measurements, TrAb, and TSI at the time of surgery were collected. The type of orbital decompression (i.e., medial wall, lateral wall, posterior floor, and/or combination; endoscopic versus nonendoscopic), pre- and postoperative Hertel measurements, and strabismus surgery follow-ups were also collected. With multiple linear regression analysis, we will be able to determine whether any of these factors correlate to poorer surgical outcomes for specific surgical techniques.

Results: Preliminary analysis of 37 patients with an average 6-month follow-up suggests that any history of tobacco usage leads to significantly poorer reduction in Hertel exophthalmos compared to patients with no tobacco history (p = 0.044). Preliminary analysis showed no significant correlation between TrAb and TSI antibody levels or BMI at the time of surgery and surgical outcomes (p = 0.205, p = 0.309, p = 0.700, respectively).

Impact: These findings will have important clinical applications, informing providers and their patients of relevant risk factors when deciding whether to pursue and/or the extent of orbital decompression.

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024